For complex polydactyly, it used to be thought that 4 ~ 6 years old before school is the best time for most operations. Therefore, children can cooperate, the anatomical structure is clear, and the psychological abnormality of children can be prevented. However, in Europe, America and Japan, it is believed that the sooner the deformity is corrected, the better, starting from about 6 months after birth. They believe that the period from 6 months after birth to 3 years old is the period to establish the basic function of the hand, and it is expected to achieve perfect hand function during this period. The clinical application of surgical microscope can reduce the damage to tissue, so the operation time can be advanced. For simple polydactyly, it is better to operate 6 months after birth; For complex polydactyly with severe deformity and tissue defect, polydactyly resection, tissue transplantation or displacement, functional reconstruction and other operations should be performed after 1 year, and regular review should be made until the development stops.
Polydactyly is a congenital disease. Multi-fingering is also called repetitive fingering. There are multiple fingers and mirror hands in tissue duplication, which are mainly divided into three types: thumb multiple fingers before axis, central multiple fingers after axis and little finger multiple fingers. Because of its obvious signs, it can be found and diagnosed during childbirth. Multi-indications are the most common congenital malformation of hand, and the incidence is higher in men than in women, which is about 1. 5∶ 1; Right hand is more than left hand, the ratio is 2 ∶1; The incidence of both hands is about 10%. Thumb polydactyly is multiple, accounting for more than 90% of the total.
There are many kinds of congenital malformations of hands, one of which is genetic factors. Two thirds of the cases in this group have family history of hereditary diseases and atavism. Secondly, environmental factors, such as certain drugs, virus infection, trauma, the stimulation of radioactive substances, especially the pollution of modern industry, can all become teratogenic factors. Thumb polydactyly is caused by abnormal development of ectodermal parietal crest, which extends proximally and slowly retracts.
Therefore, from the perspective of prevention:
(1) to promote prenatal and postnatal care;
(2) to prevent or reduce industrial pollution, such as radioactive substances;
(3) In the first three months of pregnancy, use drugs with caution or without drugs.
Selection of surgical methods:
(1) Bil-haut-Cloquet method is often used to balance multiple fingers, but it is easy to be complicated with dysfunction such as nail dislocation, nail fracture and abnormal healing of phalanges after operation. At present, when the size of the finger is larger than 2/3 of the healthy side, the fingernails, nail beds and phalanges of the fingers are removed, and the skin flap with appropriate size is reserved to combine with the thumb to improve the appearance of the thumb. Although the phalanx of thumb is slightly smaller, it has good function and appearance, which can avoid the complications of Bilhaut-Cloquet operation.
(2) Reconstruction of abductor pollicis brevis and cutting off the radial collateral ligament of metacarpophalangeal joint are the keys to successful proximal phalangeal paired polydactylectomy. Therefore, the muscle entry point of abductor pollicis brevis should be cut off and peeled off under the periosteum and fixed on the extensor digitorum brevis tendon and joint capsule. When cutting the radial collateral ligament, a small triangular cartilage block should be fixed on the radial cortical bone with the base of the proximal phalanx of the thumb preserved to strengthen the stability of the joint. When fingers are amputated, extensor tendons and flexor tendons can be preserved to strengthen the function of extension and flexion, or to reconstruct the lateral collateral ligament. When the congenital defects of extensor tendon and flexor tendon are preserved, the extensor tendon and flexor digitorum superficialis tendon can be transferred to rebuild the thumb preservation function.
(3) Orthopedic osteotomy of metacarpal and phalangeal bones is suitable for people after 1 year; The reconstruction of palmar function should be completed after 3 years old, and the tendon of palmar longus muscle should be transferred more.
(3) Importance of long-term follow-up: The early curative effect of polydactyly is satisfactory, but with the development of children, secondary malformation is not uncommon. In this group, 32 cases underwent secondary orthopedic reconstruction 2 ~ 15 years after operation, accounting for 13 of the total. 6%(32/234)。