Reconstruction of the thumb in apert syndrome

Reconstruction of the hand in Apert syndrome continues to be one of the most daunting challenges in congenital hand surgery. The thumb presents a unique problem in these children, as it is usually short with radial angulation. In addition, there is usually a paucity of skin along the radial side of the thumb. Previous treatment strategies for correction have centered around either on osteotomy of the often fused phalanges, or release of the abnormal abductor pollicis brevis insertion. This paper presents our treatment strategy for this deformity that includes release of the abnormal abductor pollicis brevis insertion, osteotomy, and advancement flaps. By using this approach, we are able to address all of the deforming forces that cause the thumb deformity.