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Arch Hand Microsurg > Volume 18(4); 2013 > Article
Journal of the Korean Society for Surgery of the Hand 2013;18(4):147-154.
Published online December 30, 2013.
DOI: https://doi.org/10.12790/jkssh.2013.18.4.147   
Modified Bilhaut-Cloquet Procedure for Convergent Type IV of Duplicated Thumb
Dong Ho Kang, Jae Hyun Kim, Hyun Jae Nam, Ho Jun Cheon, Young Woo Kim, Sang Hyun Woo
Cheon & Woo's Institute for Hand & Reconstructive Microsurgery, W Hospital, Daegu, Korea. handwoo@hotmail.com
Received: 15 November 2013   • Revised: 8 December 2013   • Accepted: 10 December 2013
Abstract
Purpose
The authors applied modified Bilhaut-Cloquet procedure to convergent type of Wassel type IV duplicated thumb. In order to avoid secondary Z-deformity and dysfunction of the reconstructed thumb, the authors modified operative techniques of Bilhaut-Clopuet procedure.

Methods
Fourteen patients received Bilhaut-Cloquet procedures to correct duplicated thumbs from October 2008 to May 2013. Five patients were balanced type and nine patients were unbalanced type. Mean age at the operation was 20.1 month-old (range, 12-52 month-old). Angular deformity, joint stability, range of joint motion and cosmetic outcome were estimated based on Tada score. Postoperative subjective satisfaction score of the parents was evaluated using a 100-points scale.

Results
Mean subjective satisfaction score was 75 points at 28 months after the operation. Radiologic study showed bony union of proximal phalangeal bone and stable joint in all patients. Mean range of motion was 20 degrees in interphalangeal joint and 73 degrees in metacarpophalangeal joint. Based on Tada score, the results were good in ten patients (72%), fair in two (14%) and poor in two (14%). Seven patients who were able to follow up for a long term showed no significant difference in length of proximal and distal phalangeal bones compared to the opposite thumb.

Conclusion
Modified Bilhaut-Cloquet procedure can be applied not only to balanced type of convergent Wassel type IV duplicated thumb, but also to unbalanced type, that focused on functional reconstruction and cosmetic improvement.
 
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