22 March 2023

22 March 2023

Unique operations in the department of paediatric traumatology

The team of Dr Vladimir Zavarukhin, Candidate of Science (Medicine), Head of the Department of Traumatology No 3 of the Pirogov Clinic of High medical Technologies at St Petersburg University, a traumatologist-orthopaedist, performed an operation on a one-year-old infant with a rare hand pathology - quadrupling the first (thumb) finger.

The distinct feature of the operation performed is that such a variant of polydactyly (from poly - many, dactylos - finger) is extremely rare. The Rotterdam classification of polydactyly of the thumb mentions only options with tripling of the first finger so far. No hand reconstruction operations due to qaudrupling the first finger have previously been described in the world scientific literature yet.

To develop the tactics of the surgical intervention, doctors carried out careful and multi-stage diagnostics. The X-ray of the hand revealed that two fingers were connected at the level of the so-called ‘delta-phalanx’.

The operation involved the removal of one finger, the area of the bifurcated trapezoid bone facing it, which prevented the abduction of the main first finger. At the same time, the most functional first finger was brought to the position of the removed one, thus increasing the width of the first interdigital space, and a part of the growth zone was removed on the delta phalanx, which used to block the normal growth of the finger and deflect it to the side during growth. Moreover, an extra phalanx was removed and a corrective osteotomy was performed with aligning the finger.

This immensely complex and non-routine operation required high precision: not just only was it about isolating fingers from all sides, but it was also necessary to make circular cuts at their base and isolate arteries and veins so that they could be completely separated and to provide the preserved finger with vessels and nerves essential for normal functioning.

The non-standard reconstruction was successful; now the little patient is already using the operated hand and the course of recuperation has been completed. In the future, the function of the infant’s hand will practically not differ from the ones of its peers.

Vladimir Zavarukhing has already been attending hand disorders for more than 10 years. In the four-year period, he managed to create in his vicinity several teams of medical and like-minded experts who are capable of performing one-of-a-kind operation. Vladimir’s scientific achievements are: six patents, more than 50 publications on hand surgery, plastic surgery, traumatology, orthopaedics and microsurgery, regularly reporting at all-Russia and international conferences and the uncountable number of children and their parents whose lives the team has improved.