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Absent flexor pollicis longus: case report with review of literature.

ABSTRACT: An asymptomatic absence of flexor pollicis longus without association with any other anomaly or hypoplasia of the thenar muscles in a 28-year-old patient is reported due to its rarity. The inability to flex the interphalangeal joint of the thumb and the absent flexor crease of the thumb led us to identify the absent tendon, and the tendon could not be palpated in the flexor crease of the thumb. Routine X-rays, ultrasound scans, and a computed tomography with soft tissue enhancement was used to confirm and document the condition. The patient was not referred for a magnetic resonance imaging, facilities for which are not available in the center where the author is working, as he was not keen in surgical interference.

SUBMITTER: Suresh SS

PROVIDER: S-EPMC2654941 | biostudies-other | 2009 Mar

REPOSITORIES: biostudies-other

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Project description:In the treatment of Gustilo Type 3B open tibial fractures, it is important to perform soft tissue reconstruction and bone reconstruction simultaneously. Gastrocnemius muscle and soleus muscle flaps are generally used as rotational flaps for the tibia. The distal third of the tibia can often not be covered with the gastrocnemius muscle and soleus muscle flaps. Treatment distal to the distal third of the tibia is difficult because fewer flap options are available. In the present report, we describe our experience with a Gustilo Type 3B open tibial fracture treated by gastrocnemius muscle and soleus muscle flaps, along with an additional proximally based flexor hallucis longus flap, which is a rare procedure.The participant was a 17-year-old male who injured his left tibia in a motorcycle traffic accident. Physical examination revealed a wound of 13 cm × 7 cm extending from the medial lower leg to the posterior aspect, with extensive skin loss. There was no nerve or vascular injury. The tibia was exposed, with detachment of the periosteum. The radiograph revealed a tibial shaft fracture. The AO/OTA classification was 42-A3.3, and it was classified as a Gustilo-Anderson Type 3B fracture. Gastrocnemius muscle and soleus muscle flaps were lifted in the area of the soft-tissue defect and then, placed over the tibia. Despite this, the distal portion of the tibia remained uncovered. Therefore, a flexor hallucis longus flap was lifted and placed over the distal portion of the tibia. On day 7 after the injury, the external fixation device was removed and the tibial shaft was fixated with two Ender nails (4.5 mm in diameter). The clinical course was satisfactory, and the skin graft and flap were successful. Bone union was achieved without infection, and the resulting range of motion was normal.For the treatment of Gustilo-Anderson Type 3B open tibial fractures, early treatment of the soft-tissue defect is vital. We surgically treated a Gustilo-Anderson Type 3B open tibial fracture with gastrocnemius muscle and soleus muscle flaps, along with an additional proximally based flexor hallucis longus flap, which is a rare procedure. In the event of a soft-tissue defect in the distal third of the tibia, the use of a proximally based flexor hallucis longus flap is an effective surgical approach.

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Absent flexor pollicis longus: case report with review of literature.

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