ABSTRACT

Polydactyly is the most common congenital anomaly of the hand. The aim of treatment in radial polydactyly, which is also named as thumb duplication, is to achieve a functional thumb that is cosmetically identical to the counterpart at the normal side. Thumb duplications are commonly grouped according to the Wassel's classification, and the surgical correction is suggested to be accomplished until the age of one. In an adult patient with a congenital hand anomaly, which was deemed to be a radial polydactyly, the rudimentary one of the duplicated digits was observed to be localized extraordinarily far from the dominant one in the first web space, and it was noted that the related anatomopathology could not be implicated in any group of the Wassel's classification. Current deformity was inferred to be a thumb duplication, which showed an aberrant growth due to lack of the treatment on proper time. Dominant finger was preserved and stabilized in functional position. Instead of total amputation, soft tissue of the rudimentary finger with extraordinarily distant position was passed through a subcutaneous tunnel after harvesting as an island flap upon its pedicles and used for augmentation of the hypoplasia of the preserved dominant finger. Existence of discrete supplying pedicles to the rudimentary finger was ensured and screened by preoperative angiographic examination. Pinching and gripping of the hand were restored, and a cosmetically acceptable thumb was achieved. Even in such cases in which the localization of the rudimentary finger is extraordinarily far from the dominant one, instead of total removal of the rudimentary one readily, utilization of its necessary parts as an island flap in order to replace the defective preserved finger should be taken into consideration as a better reconstructive option. Preoperative angiographic examination will ascertain the availability and reliability of such a treatment option.