Opponensplasty using Extensor Indicis Proprius

Journal of the Korean Society for Surgery of the Hand 1997;2(2):321-330.
Published online January 1, 1997.

Duke Whan Chung

고유인지신건을 이용한 무지대립성형술

정덕환

Abstract

Functional impairment of the hand with loss of thumb opposition is serious handicap. Etiologies of the unable to opposing thumb are median nerve injury, local soft tissue loss of thenar area and some cases associated with brachial plexus injuries and diseases involving nerve tissues such as poliomyelitis and Hansens disease. Many modalities have been devised in order to restore opposition. Each surgical methods has various advantages and shortcomings and limitation of the application depends etiology of the functional impairment and associating conditions. An analysis of 19 opponensplasty using Extensor Indicis Proprius routed subcutaneousely around the ulnar side of the forearm across the palm to metacarpophalangeal joint and Extensor pollicis longus tendon near by. The main indication of this method are high median nerve injury and any combined and ulnar nerve injury. We underwent this technique not only combined injuries but single high median nerve injury, futhermore thenar muscle lost cases and brachial plexus injury cases were included. With these clinical analysis, we can get several results as: oyerall functional results with this procedure are 47.4% excellent, 42.1% good, 10.5% fair . Patients with solitary median nerve injury show much superior results than combined nerve injuries or thenar muscle lost cases. Rate to return to original occupation without significant difficulties was 36.8% which suggests it is just a limited modalities to improve functions in patients with median nerve paralysis, we need innovate to improve these handicaps. Anyways we can conclude opponensplasty with extensor indicis propris is one of the best methods which reconstruct opposition impairments in any reasons with minimal donor morbidities.