Kompleksa pēcoperācijas rezultātu izvērtēšana bērniem ar iedzimtu plaukstas pirmā pirksta hipoplāziju jaunas ķirurģiskas plaukstas rekonstrukcijas metodes pamatojumam

Title. Complex postoperative outcome evaluation for the congenital thumb hypoplasia treatments to promote the new surgical method for the thumb hypoplasia reconstruction. Congenital upper extremity deformations are rare, the reported incidence is from 0.15–0.2%.[44,51] Vast majority ~ 70% are slight deformities, e.g., syndactyly or polydactyly, and only 1–2 % out of all congenital defects is thumb hypoplasia or development disorder. Thumb is very important for hand’s functionality, it provides up to 50% from hand’s performance and thus in child’s development. Proper pinch grip formation at the age of 12–16 months can affect child’s psychoemotional development. Thumb reconstruction historically has been significant, the first successful thumb reconstruction is considered the staged procedure performed by Nicoladini in 1897. With advancement of optical zoom instruments, in 1965 Buncke did the first microvascular toe-to-hand transplantation on rhesus monkeys. The surgery was successful, although only one of the transplanted toes survived. Shortly after – in 1968 Cobett performed toe-to-hand transplantation on a human patient.[19] The first ever second toe transplantation for congenital thumb defect’s surgical treatment was done in 1976 by May.[72] The development of the microsurgery in Latvia started in 1985, then the department of microsurgery was founded in hospital ‘Gailezers’. The first microvascular toe-to-hand transplantation in Latvia for the child patient with congenital defect was done in 2008. With continuous improvement of congenital hand defects’ treatment techniques in 2010 a new technique for thumb hypoplasia stage IIIb–V was developed – second toe transplantation with MTP joint arthrodesis. The technique allows to maintain five-digit hand and provides good functionality ad aesthetics.[75,76] For thumb hypoplasia stage II – IIIa reconstruction second digit’s tendon transposition is used. The EIP tendon transposition technique was created in 2007. In this research a detailed literature analysis on congenital thumb hypoplasia treatment options and their outcomes are analyzed. The most common described method for congenital thumb hypoplasia stage IIIb–V reconstruction is pollicization, i.e., hand’s second digit is placed in thumb’s position. A functional thumb is created, but patient is left with four-digit hand, which is considered normal in western countries.[12,64] The second most common technique – foot’s second metatarsal bone transplantation, which has advantage is preserved five-digit hand, but the reconstructed thumb has little motion. In the first part of this research 21 patients were examined, 18 patients were included. In the retrospective part functionality data was analyzed, determining the strength of power and pinch grip, range of active motions in the thumb’s joints. Also for data evaluation DASH and PEDI scales were used, and for evolution for aesthetic results – VAS scale. Obtained functional data was compared with patient’s healthy (non-operated) hand and RSU institute of anatomy and anthropology, laboratory of the anthropology research on Latvia’s children functional norm’s determination results. Congenital hand deformation’s thumb hypoplasia patient’s functional data is significantly lower in comparison with healthy Latvian children. Foot’s second toe’s transplantation with MTP joint arthrodesis techniques functional results are similar to pollicization’s technique results, nevertheless VAS scale results were higher exactly to new technique. In the research’s prospective part a questionnaire was done to compare aesthetic outcomes of thumb hypoplasia stage IIIb–V treatment techniques – foot’s second toe transplantation with MTP joint arthrodesis and pollicization. The survey was completed by 285 respondents, who with statistical confidence better appreciated second toe transplantation with MTP joint arthrodesis and newly created five-digit hand is considered better looking rather than four-digit hand in case of pollicization. Foot’s second toe transplantation with MTP joint arthrodesis method’s achieved functional and aesthetic results allow us to change the prevailing view on the congenital hand’s first digit’s hypoplasia treatment methods and to recommend this new hand reconstruction method as an alternative to pollicization method. New surgical methode – toe to hand transplantation using MTP arthrodesis were used for treatment of two patients with congenital hipoplasia of thumb degree IIIb–V EIP transpozition methode with suberiosteal fixation were used for treatment of forteen patients with congenital hipoplasia of thumb degree II and IIIa and clasical methode – policization were used for treatment of two patients with congenital hipoplasia af thumb degree IIIb–V. Aesthetical results survey were completed by 285 responders. Received postoperative functional and aesthetical results showed that results for the new – transplantation methode is similar like policization but cosmethical outcome for tthe new methode was evaluated much hire then clasical pollicization methtod.