It is a spectrum of congenital deformity of the thumb varying from small defects to complete absence. It can be isolated, when only the thumb is affected, and in 60% of the cases it is associated with deficiency of lateral (radial) hand structures.
Blauth classification:
Type I –small thumb.
Type II – small thumb with muscles deficiency.
Type III – small thumb with muscles and skeletal deficiency.
Type IV – Small thumb attached to the hand by a soft tissue bridge (floating thumb or ‘pouce flottant’).
Type V – Total absence of the thumb.
Type I: good function… does not require surgery.
Type IIIB, IV and V: ablation of any thumb elements and reproduce thumb function by shortening and rotating the index finger (pollicization) and reconstruction of deficient tendons and ligament (UCL, FPL, EPL etc.)
Outcome depends on the location and size of the fistula and status of surrounding tissues. Although most of the fistula closes after the surgery, some may recur and requires further surgery.
It usually takes less time than the original hypospadias repair and completes in less than an hour.
The surgery is performed under general anaesthesia and as a day care procedure. Patient can go home the same day after recovery from anaesthesia.
The most common complication is recurrence of the defect. Others complications include infection, difficulty in urination and stricture formation
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