Reanimation of thumb opposition by the extensor pollicis longus. Report of sixteen cases.
Among some 65 techniques for restoring thumb opposition found in literature, the authors chose the extensor pollicis longus transfer (EPL) onto the abductor pollicis brevis (APB) through the interosseous membrane. This technique described by Duparc et al. in 1971 was codified by Bureau et al. in 1980 using a series of 9 cases. The sufficient force and length of this transfer, associated with its direct course by redirection through the interosseous membrane make it a docile, reliable motor unit as shown by the 16 cases studied. Performed on 11 median-ulnar palsies, 6 isolated median palsies and on one complete avulsion of lateral thenar muscles, only 16 of these 18 transfers could be satisfactorily followed and reviewed from 7 to 35 months later. In our series, 14 of the 16 cases have recovered functional opposition and are using it. After a review of the surgical technique the authors emphasize some practical aspects: dissection of the EPL which may be delicate, resection of the IM which should be adequate, and choice of the reflexion pulley and how to construct it. Results as well as sequelae linked to the choice of the EPL are then analysed.
D000293:Adolescent; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008722:Methods; D008875:Middle Aged; D011183:Postoperative Complications; D013709:Tendon Transfer; D013933:Thumb / Q000601:surgery*; D013997:Time Factors