Apport d'une nouvelle plastie à la reconstruction de la première commissure dans les malformations congénitales : À propos d'une série de 54 patients

Introduction Only a few studies are available in the literature on the specific problem of the congenital contracture or absence of the first web in hand deformities, and first web reconstruction. Material and methods Sixty-seven first web plasties in 54 patients were retrospectively analyzed: they included 44 cases of classical plasties, i.e., Z-plasty (21 cases) ; dorsal flap plasty of the index (19 cases), thumb (1 case), or the hand (10 cases), and 16 cases of’ pseudo-kite flap. Results The results were difficult to assess, as the syndromes were dissimilar and the deformities were not comparable (e.g., Apert syndrome versus Poland syndrome). However, it was found that the ‘pseudo-kite’ technique which was applicable to certain cases resulted in a web extension of 3.2 cm without any deepening. Discussion No method of classical assessment can be used to comprehensively evaluate the results of first web reconstruction due to the wide variability in clinical characteristics, the lack of patient cooperation in this young age group, the possible MPJ articular thumb instability, and growth factors. Although 4-flap Z-plasty is an adequate technique for non-severe first web deformities, the ‘pseudo-kite’ flap approach is useful in more severe cases. In 13 cases, a peroperative measurement before and following plasty was made, and a significant increase (205 %) in planimetric and stereotactic gain compared to pre-plasty findings was noted. Conclusion It does not seem logical to have a particular preference for a certain approach when considering first web reconstruction in congenital malformations. Each technique has its advantages and disadvantages, depending on patient age, the type of malformation, the state of the thumb, the extent of the first web deformity and the possible presence of scar tissue.