It is a congenital condition in which a child has two thumbs (an extra digit on the radial side of the hand). 

SYMPTOMS 

Depend on severity of disease

Wassel’s classification  

Type I: bifid distal phalanx (2%),   Type II: duplicated distal phalanx (15%) 

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

Type IV: duplicated proximal and distal phalanx (43%) 

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

Type VI: 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 the approximate duration of the procedure?

Few minutes to hours, it depends on thumb deformity.

3. What setup is required for the procedure?

It depends on deformity of the thumb; it can be performed in a daycare setup.

4. What are the most common complications?

Very few complications, depending 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