Thumb Duplication

Chapter 28 of Volume 1, Hand & Upper Limb. Revision notes for the FRCS (Plast).

What this chapter covers

• Wassel Classification (Radiographic)
• Surgical Techniques
• 1. Excision & Reconstruction (Most Common)
• 2. Bilhaut–Cloquet Procedure
• 3. Webspace Reconstruction (if needed)
• 4. Triphalangeal Thumb (Type VII)
• Associated Conditions
• The Case & Describing the Hand
• Q. Please describe this hand.
• 1. Essentials
• 2. Wassel Classification (radiographic) - with frequencies
• Wassel IV subtypes (Horii) - because type IV is the commonest
• 3. Assessment
• 4. Surgical Principles
• Ablation + reconstruction (Wassel III-VI and asymmetric I/II)
• Bilhaut-Cloquet - for SYMMETRIC, equal Wassel I/II
• First web & triphalangeal
• 5. Complications & Outcomes
• 6. Associations - Screen, Especially Triphalangeal / Bilateral
• 7. How to Score Highest in This Station
• 8. Higher-Level Discriminator Pearls