Surgery Spotlight: Type 1 Duplicated Thumb Reconstruction-Surgery Spotlight: Type 1 Duplicated Thumb Reconstruction

Surgery Spotlight: Type 1 Duplicated Thumb Reconstruction

Video Transcription

Hello, my name is Kevin Chung, Professor of Plastic Surgery at University of Michigan. I have a great interest in congenital hand reconstruction.  This is a case in which the patient has duplicated the distal phalanx and my impression is that the excised thumb may not have shared head of the proximal phalanx.  When I say shared head of the proximal phalanx, the proximal phalanx may have two condyles supporting each of the distal phalanges.  When I expose the dorsum, you can see that there's no extra condyle, in fact, the extra thumb is just attached to the side of the collateral ligament and so the boning component  can be excised entirely and there's really no need to recreate the collateral ligament because the collateral ligament is still intact.  So this is a duplicated thumb, type 1, in which the articular surface is not, is it type 2? It's hard to tell. It's hard to tell.  Either type 1 or type 2, but the thing is on x-ray, it doesn't seem to have a conjoined tendon, I mean conjoined bone, very similar to conjoined tendon in which, conjoined articular  surface of the proximal phalanx in which you need to reconstruct the collateral ligament, but let's see.  We are going to expose the dorsum to the dorsal incision to see the architecture, architecture  of the thumb and then we're going to go straight down to see the extensor mechanism and then based on that, and then we're going to see what we need to do.  So we usually make this incision first to assess the anatomy, yeah, come on my side, save the vein, come on my side, come on this side, save the vein, okay, okay, come in,  okay, so you have this one, what is this, the shear, make an incision here, okay, come more proximally, give me the skin tone please, okay, now we have, now we have a much better  assessment, pick up please, so what Dr. Nell is trying to figure out is that is there a shear joint, is there a shear joint that we need to save the collateral ligament on this  side so we can reattach it, and so right now what I'm seeing is, yeah, it's kind of right here, free right here, okay, open this up and see, okay, now she goes through the cartilage  of the extra thumb and let's see, because then what we can do is we can kind of stress the thumb is stable, see that, the thumb is very stable, the collateral ligament is okay,  so the bone is only peripherally attached to the collateral ligament area, yeah, okay, so this is a much simpler operation in which what Dr. Nell is going to do, she's going  to complete the excision and then we're going to close the soft tissue without any particular need for, I'm sorry, without any particular need for ligament reconstruction, and the  reason we need to do ligament reconstruction is when they share a common joint, so there will be a condyle for the proximal phalanx for the extra thumb and there will be a condyle  for the native thumb.  Okay, so very similar to the last case, now we're going to lift up the skin flap that we can re-drape over the area, and we're going to excise this one.  If this thumb were to have a common condyle, which means that there's a condyle on the proximal phalanx for this, there's a condyle on the proximal phalanx for that, and there's  a collateral ligament that attaches right here, what Dr. Nellens would do next would be to remove the collateral ligament from this side, and take it off, and remove the bone.  At the same time, shave off the head of the proximal phalanx while retaining the attachment of the collateral ligament, and once this is removed, then we'll stabilize the thumb,  and then we'll reattach this collateral ligament periosteal complex to the distal phalanx, which essentially recreates the collateral ligament on that side, okay?  But in this case, it's not necessary, because, okay, and the good thing about this case, much simpler, is that if you stress the collateral ligament, it's stable, so there's no need  to recreate anything, and now, now you have this nice thumb, it's deviated a little bit, but I'm not going to correct it now, I'm going to see how the kid grows, and later on we  can do something with it if necessary. Let's get some, get a knife, let's get some fibrochromic, let's kind of re-drape this one over this, simpler, huh, this one?  This is a much simpler operation in which a bony component is excised and then the skin is redraped over the defect and you have a nice aesthetically appearing thumb.

Video Summary

In this video, Professor Kevin Chung from the University of Michigan discusses a surgical case of a patient with a duplicated distal phalanx thumb. The surgery aims to remove the extra thumb, which is not sharing a proximal phalanx head, simplifying the procedure as the collateral ligament is intact. Dr. Nellens performs the excision without needing ligament reconstruction, as the bone is only peripherally attached. The operation's simplicity allows for the skin to be re-draped over the area, resulting in an aesthetically pleasing thumb. Future corrections may be considered based on the child's growth.

Asset Caption

In this video, Dr. Chung performs part 1 of duplicated thumb reconstruction.

Surgeon

Kevin Chung, MD

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Keywords

Surgical Videos

Surgery Spotlight

Hand

Nerve

Kevin Chung MD; Memben

duplicated distal phalanx thumb

thumb surgery

collateral ligament intact

aesthetic thumb reconstruction

pediatric surgical case