It is a congenital condition in which a child has two thumbs (an extra digit on radial side of
hand).
Symptoms…..Depend on severity of disease
Wassel’s classification
TYPE I: bifid distal phalanx (2%),                

TYPEII: duplicated distal phalanx (15%)

TYPE III: bifid proximal phalanx with duplicated distal phalanx (6%)

TYPEIV: duplicated proximal and distal phalanx (43%)

TYPE V: bifid metacarpal with duplicated proximal and distal phalanx (10%

TYPEVI: duplicated metacarpal, proximal and distal phalanx (4%)

TYPE VII: triphalangeal thumb accompanied by a normal thumb (20%).

Operative Procedure…The goal is to create the best thumb possible using parts of each duplicate.
Removing one duplicate and reconstructing the other. – For types III and IV, or types I and II with
significant asymmetry. The radial duplicate is usually proximal and smaller than the ulnar. – Radial
collateral ligaments should be reconstructed
Sharing equal parts of each and removing adjacent inner halves of each duplicate (The Bliaut-Cloquet
procedure).

FAQS
1. At what age surgery should be performed?
Surgery is usually performed at 1 year, prior to development of thumb-index pinch.
2. What is approximate duration of procedure?
Few minutes to hours, it depends on thumb deformity.
3. What setup is required for procedure?
It depends on deformity of thumb it can be performed in a day care setup.
4. What are the most common complications?
Very few complications, depends on its type, infection, incomplete excision.

This complication can be easily avoided by performing surgery under loupes magnification, aseptic
technique, and postoperative care and by performing operation by properly trained plastic surgeon.

Written by : Dr. Afaq Saleem
Copyrights: Pakistan association of Plastic Surgeons