"Face to face": a new method for the treatment of polydactyly of the thumbthat maximises the use of available soft tissue

Some patients with distal phalangeal polydactyly of the thumb have severe h ypoplastic pulps that are difficult to make sufficiently large with either the fillet flap method or a symmetrical combination, the Bilhaut-Cloquet me thod. We have devised a new method to reconstruct the largest possible pulp by resecting only a minimum amount of soft dorsal skin tissue with one nai l and not resecting any of the palmar skin of the thumbs. By contrast, othe r procedures require some resectioning of soft tissue of both the dorsal an d the palmar skin. We have treated 13 cases with distal phalangeal polydact yly of the thumb since 1988 in this way. All the thumbs were successfully r econstructed with a sufficiently large pulp. The only problem was slight in stability of the skin of the pulp after the operation, but this condition g radually improved during a five-year follow up. We think that this method f acilitates the reconstruction of a sufficiently large pulp when both bifid pulps are hypoplastic.