American Association of Plastic Surgeons

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Preservation of Metacarpophalangeal Joint Vascularity May Protect Against Physeal Arrest in Index Finger Pollicization
Meera Reghunathan, MD1, Katharine Hinchcliff, MD1, Courtney Schneidau, PA2, Chris Stutz, MD2, Marybeth Ezaki, MD2, Scott Oishi, MD2
1UC San Diego, San Diego, CA, USA, 2Center for Excellence in Hand and Upper Extremity Surgery, Texas Scottish Rite Hospital for Children, Dallas, TX, USA

PURPOSE: Proximal phalanx physeal arrest is one of the most common complications of pollicization at rates of nearly 25%. Anatomic dissection of the metacarpophalangeal joint (MCPJ) demonstrated a consistent vessel deep to the interosseous muscles that arborized on the volar metacarpal neck, arising from either the deep anterior metacarpal artery or the ulnar proper digital artery. The aim of this study is to determine if preservation of blood supply to the index MCPJ decreases the rate of physeal arrest.
METHODS: A retrospective review was conducted at a single institution of 41 pollicized digits in 35 patients with two year minimum radiographic follow up. Other complications evaluated included non-union at the pollicized digit base and clinical instability at the new carpometacarpal joint. Findings were compared to historical controls, which were performed by our group prior to routine identification and sparing of the MCPJ blood supply. No other modifications to surgical technique were made between the historic and current patient cohorts.
RESULTS: Two patients had radiographic evidence of physeal arrest, one of which was partial and the other complete, for an arrest rate of 4.9%. This was significantly less than the arrest rate in our historical cohort of 24.7% (21 of 85 patients), p = 0.007. Five patients did not have bony union at the base of the index metacarpal, and one patient had clinical instability at the new carpometacarpal joint.
CONCLUSION: This finding suggests that sparing of the physeal blood supply is preventative against proximal phalanx physeal arrest.


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