Introduction: Thumb polydactyly is a common congenital anomaly that requires reconstruction to restore joint stability, motion, and cosmetic symmetry. Conventional techniques often fail to adequately reestablish radial collateral ligament (RCL) support, contributing to postoperative deviation or instability. This study describes an autologous periosteal-cartilaginous flap technique for RCL reconstruction after an excision of the radial duplicate digit. Methods: A retrospective case series was conducted at Prince Sultan Military Medical City, Riyadh. Patients who underwent thumb polydactyly correction with autologous periosteal-cartilaginous RCL reconstruction were included. Clinical variables, complications, and functional outcomes were recorded. Functional assessment was performed using the Thumb Assessment after Digital Anomaly (TADA) score, evaluating range of motion, joint stability, and alignment (0 to 5 scale). The operating surgeon assessed cosmetic outcomes; these assessments carry inherent observer bias and should be interpreted with caution. Results: Four patients (ages 2 to 22 y) with Wassel types II, IV, VI, and VII met the inclusion criteria. All procedures were completed without intraoperative complications. At 4 months to 2 years of follow-up, TADA scores were 4/5, 3/5, 5/5, and 5/5. Three patients achieved ≥75% of the normal range of motion, and all demonstrated stable MCP joints. Alignment was optimal (<10 degrees deviation) in 3 cases. Cosmetic outcomes were uniformly rated good to excellent, with no postoperative instability, stiffness, or painful scar formation. Conclusions: Autologous periosteal-cartilaginous flap reconstruction demonstrated promising functional and cosmetic outcomes across a heterogeneous patient group; however, given the small sample size and variability in patient characteristics, these findings should be interpreted with caution. This approach represents a potentially viable reconstructive option for restoring RCL stability in thumb polydactyly. Larger prospective studies are needed to validate long-term effectiveness.
Akkour et al. (Thu,) studied this question.