J Korean Soc Surg Hand.  2013 Dec;18(4):147-154. 10.12790/jkssh.2013.18.4.147.

Modified Bilhaut-Cloquet Procedure for Convergent Type IV of Duplicated Thumb

• Kang DH
• Kim JH
• Nam HJ
• Cheon HJ
• Kim YW
• Woo SH

• KMID: 1840495
• DOI: http://doi.org/10.12790/jkssh.2013.18.4.147

Abstract

PURPOSE
The authors applied modified Bilhaut-Cloquet procedure to convergent type of Wassel type IV duplicated thumb. In order to avoid secondary Z-deformity and dysfunction of the reconstructed thumb, the authors modified operative techniques of Bilhaut-Clopuet procedure.
METHODS
Fourteen patients received Bilhaut-Cloquet procedures to correct duplicated thumbs from October 2008 to May 2013. Five patients were balanced type and nine patients were unbalanced type. Mean age at the operation was 20.1 month-old (range, 12-52 month-old). Angular deformity, joint stability, range of joint motion and cosmetic outcome were estimated based on Tada score. Postoperative subjective satisfaction score of the parents was evaluated using a 100-points scale.
RESULTS
Mean subjective satisfaction score was 75 points at 28 months after the operation. Radiologic study showed bony union of proximal phalangeal bone and stable joint in all patients. Mean range of motion was 20 degrees in interphalangeal joint and 73 degrees in metacarpophalangeal joint. Based on Tada score, the results were good in ten patients (72%), fair in two (14%) and poor in two (14%). Seven patients who were able to follow up for a long term showed no significant difference in length of proximal and distal phalangeal bones compared to the opposite thumb.
CONCLUSION
Modified Bilhaut-Cloquet procedure can be applied not only to balanced type of convergent Wassel type IV duplicated thumb, but also to unbalanced type, that focused on functional reconstruction and cosmetic improvement.

Keyword

Convergent type of Wassel type IV; Bilhaut-Cloquet procedure

MeSH Terms

Congenital Abnormalities
Follow-Up Studies
Humans
Joints
Metacarpophalangeal Joint
Parents
Range of Motion, Articular
Thumb*

Figure

• 

  Fig. 1. Surgical procedure of Bilhaut-Cloquet procedure for duplicated thumb of convergent Wassel type IV. (A, B) Preoperative design. (C) Design for excision of central contents. (D) Longitudinal osteotomy with oscillating saw. (E) Remained phalangeal bones are fitted accurately and transfix using Kirschner wires. (F, G) Divided extensor and flexor tendon are centrally approximated and repair with continuous figure of 8 suture method. (H) Design for Z-plasty on pulp area. (I, J) Immediate postoperative view.

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  Fig. 2. Case 1. (A, B) Preoperative photograph and radiograph. Balanced Wassel type IV duplicated thumb. (C) Radiograph at postoperative 14 months. (D, E, F) Photograph at postoperative 14 months. Acceptable cosmetic appearance without nail deformity.

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  Fig. 3. Case 2. (A, B) Preoperative and postoperative radiograph. Unbalanced convergent type Wassel type IV duplicated thumb. (C) Photogragh at postoperative 38 months. (D, E, F) Photograph at postoperative 38 months. Acceptable cosmetic appearance of reconstructed thumb with good range of motion (metacarpophalangeal joint flexion, 80°; interphalangeal joint, 45°).

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