Friday, October 28, 2011

Pollicization- Creating a New Thumb

Pollicization is the hallmark congenital hand surgery.  It is performed for patients with absent or severely diminished thumbs.   The thumb is vital for overall hand function and in adults, it is estimated that the thumb provides 40% of hand function.  A normal or reconstructed thumb allows for grasp of large objects (think: soda can), a task that is impossible when using only the fingers.  It can also simplify tasks requiring small object manipulation (think: stringing beads), very challenging using only the fingers.   A thumb is also important for thumb appearance.  A hand with four fingers and no thumb is abnormal appearing and likely to be noticed whereas a hand with a thumb and 3- fingers is often overlooked and thought to be “normal.” 

Pollicization the creation of a new thumb

Key ability provided by pollicization is pinch against index finger.

Pollicization digit on the left hand compared to right hand.
While clearly different, the new thumb improves both function and appearance.
In this operation, the index finger is rotated into the position of the thumb.  It requires shortening the index finger, repositioning muscle and tendon, preserving the arteries (bring the blood in) and veins (bring blood out), and creating new joints.  It also requires repositioning the thumb in the best position for function and appearance.  We change the dressing one-week after surgery to assure satisfactory thumb position.  The thumb is held in its new position while healing occurs.  Beginning at week 3, we tape the thumb into a functional position, which helps healing in the best position while allowing function.