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Neurovascular Island Flap for Reconstruction of Wassel IV Thumb Duplication
Xiao Fang Shen, MD1; Yong Jun Rui, MD1; Harvey Chim, MD2 1Hand Surgery, Wuxi 9th People's Hospital, Wuxi, China; 2University of Miami, Miami, FL

Introduction: A number of techniques are used for reconstruction of Wassel IV thumb duplications, with the aim of reconstruction to obtain a stable, mobile thumb of adequate size and shape. Techniques include preserving the ulnar thumb, reconstructing a contour defect with a radial neurovascular island flap and the Bilhaut Cloquet procedure. A persistent problem is the asymmetry between the reconstructed and normal contralateral thumb.
Materials and Methods: We describe our technique for reconstruction of Wassel IV thumb duplications. Either the radial or ulnar digit is preserved, depending on which digit is more functional. A neurovascular island flap is dissected out from the thumb to be removed. Specific modifications include the use of Bruner incisions dorsally (Fig. 1) and volarly (Fig. 2) to reduce scarring at the interphalangeal joint, resection of a wedge of skin dorsally for better final contour of the thumb, reconstruction of the nail fold with the flap and also complete mobilization of the island flap on its pedicle (Fig. 3) to allow easier inset (Fig. 4, 5). Nine patients in 8 children and had surgery for Wassel IV thumb duplication.
Results: All neurovascular island flaps survived with good contour, shape and symmetry compared to the contralateral thumb.
Conclusions: Reconstruction of Wassel IV thumb duplications with an island neurovascular flap allows for good symmetry in shape and size following reconstruction.

FIGURE 1. Dorsal markings

FIGURE 2. Volar markings

FIGURE 3. Neurovascular flap from ulnar duplicate (to be removed) is completely islanded on its pedicle

FIGURE 4. Final result (dorsal view)

FIGURE 5. Final result (volar view)

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