Fig 34A-2. A, Wassel type IV thumb duplication preoperatively demonstrated angulation of the larger ulnar thumb metacarpophalangeal and interphalangeal joint levels. B, surgical reconstruction of the thumb Polydactyly depicted in A included a soft-tissue coaptation flap from the excised radial digit, a closing wedge osteotomy of the thumb metacarpal, and an opening wedge osteotomy of the proximal phalanx to achieve appropriate longitudinal alignment of the digit. The radial collateral ligament of the metacarpophalangeal joint was reconstructed and the abductor pollicis brevis muscle reinserted in the retained digit.