Recent Trend of Surgery for Thumb Polydactyly : Plastic Operation Using the Removed Thumb as Fillet Pedicle

The operation method for thumb polydactyly has developed from simple removal, and it has become the standard procedure at present to collect parts to be used from each of the components and reconstruct one thumb. Traditionally this has been accomplished by the bisecting and joining procedure, known as Bilhaut-Cloquet's method, for the distal phalangeal type, and by the extended bisecting and joining method for the proximal phalangeal type. However, these procedures are technically difficult, and the cosmetic and functional prognosis has not been so good. Undoubtedly, the cause of this is that hard tissue like phalanges and nails are joined together, and recently the tendency is strong to avoid joining such tyssues as much as possible. The authors have since 1981 performed plastic operation by a modified method of the traditional bisecting and joining method, in which we remove one of the components and use the removed digit as a fillet. As the result, it has been found that our method not only makes the traditional method wholly unnecessary for the distal phalangeal type but also gives far better results than the past method for the proximal phalangeal type. Nevertheless, there are still cases that have to be treated by the traditional bisecting and joining method, and where to set the point of tangency of the methods will be a problem to be resolved in future.