Reconstruction of the Congenitally Deficient Thumb

Pr, Manske; Hr, McCarroll

doi:10.1016/s0749-0712(21)00701-0

Cited by 98 publications

(18 citation statements)

References 13 publications

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“…The modifications proposed by Manske and McCarroll (1992) created a fundamental change in the classification of Blauth. The presence or absence of the proximal metacarpal no longer defines a difference between Grades 2 and 3, but now occurs within Grade 3, between Grades 3A and 3B.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, the alterations in the Blauth classification proposed by these eminent surgeons sub-divide Grade 3 according to a change in the skeletal appearance of the metacarpal and the recommended treatment options. Although they differ in description of the stability of the CMC joint in Grade 3A thumbs, the reconstructive procedures they advise are similar to those they recommend for Grade 2, but with attention to extrinsic anomalies (Manske and McCarroll, 1992) and stabilization of the CMC joint (Buck-Gramcko, 2002).…”

Section: Discussionmentioning

confidence: 99%

“…Smith (2002) has also pointed out that it is incongruous to move what he considers to be Grade 2 thumbs into Grade 3A when they have an intact metacarpal but severe extrinsic anomalies -I agree -however, he incorrectly attributed the description of an intact but incompetent CMC joint to Manske. All agree that absence of the metacarpal base equates with CMC joint instability, but Manske and colleagues considered an intact metacarpal base to equate with CMC joint stability (James et al, 1996;Manske and McCarroll, 1992;Manske et al, 1995). Buck-Gramcko (2002) pointed out that this may not be so; Smith (2002) also acknowledges this.…”

Section: Discussionmentioning

confidence: 99%

“…The course of finger nerves and vessels can also be non-anatomic. Manske and McCarroll (1992) altered Blauth's classification (Table 1). In their 1992 article, and subsequently (James et al, 1996;Manske et al, 1995), Manske and his colleagues identified three components of a Grade 2 hypoplasia, these being: adduction contracture; instability of the metacarpophalangeal joint; and hypoplasia of the superficial thenar muscles.…”

Section: Historical Perspectivementioning

confidence: 99%

“…Blauth (1967) classified grades of thumb hypoplasia. A number of modifications have been proposed and that of Manske and McCarroll (1992) is currently broadly accepted. Their modifications, along with those of others, have led to a certain amount of confusion owing to misinterpretation and misrepresentation of the definitions of each grade.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

On the classification of congenital thumb hypoplasia

Tonkin

2013

J Hand Surg Eur Vol

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In 1937, Müller introduced the concept of a teratological sequence of thumb hypoplasia with increasing severity from mild deficiency, through severe deficiency, to thumb absence. Blauth subsequently detailed five specific grades. In 1992, Manske and McCarroll altered Blauth's classification such that Grade 3 was sub-divided into Grades 3A and 3B, according to a presence or absence of the proximal metacarpal. Buck-Gramcko added a Grade 3C in which there was only a remnant metacarpal head. This article investigates their publications and those of others to identify 'who said what' and clarify the definitions of grades of thumb hypoplasia. A modification of Blauth's classification is proposed, which retains the integrity of the concept of Müller and the skeletal and soft tissue grading of Blauth, but which also incorporates the disparate anomalies that may present in Grades 2 and 3 hypoplastic thumbs.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Historical Perspectivementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

On the classification of congenital thumb hypoplasia

Tonkin

2013

J Hand Surg Eur Vol

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Congenital hand differences

Sivakumar

Adamthwaite

Smith

2015

Plastic and Reconstructive Surgery

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Combination of fillet and triangular flaps for the web reconstruction in pollicization: A case report

Karacaoğlu

Baran

2008

Microsurgery

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Thumb hypoplasia represents a major disability requiring sophisticated reconstructive procedures. One of the basic criteria of the pollicization to construct a functional thumb is scar free web reconstruction. In this article, a technique to avoid excessive scarring in the first web space reconstruction by filleting out the hypoplasic thumb combining with a triangular flap is presented. A 5-year-old girl was presented. She had a Back-Gramcko type IV thumb hypoplasia. A triangular flap was planned on radial border of the long finger. Floating thumb was filleted out with preservation of the neurovascular bundle and transferred to the first web space while cooperating with triangular flap. Patient was followed up for 18 months. No early or late major complication was seen. Flap healed without any necrosis. The ratio of active motion in pollicized finger was measured 60% after cerebral reorientation. A satisfactory grip and pinch were seen in pollicized finger. Patient as well as her parents was satisfied with the results. Filleting out the floating thumb and combining with a triangular flap harvested by a V-Y flap design is a good option to avoid excessive scarring in reconstruction of the first web space in pollicization. It is strongly recommended that floating thumb should be preserved for future pollicization, and any attempt to amputate it in early years of life should be postponed till the time of definitive surgery.

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Reconstruction of the Congenitally Deficient Thumb

Cited by 98 publications

References 13 publications

On the classification of congenital thumb hypoplasia

On the classification of congenital thumb hypoplasia

Congenital hand differences

Combination of fillet and triangular flaps for the web reconstruction in pollicization: A case report

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