The decision to proceed with pollicization is not easy. It is most straightforward when the thumb is completely absent and is most difficult when the child has any thumb, as families very reasonably would like to keep and improve the small thumb rather than excise it and pollicize the index finger. However, the majority of congenital hand surgeons (especially in the United States) believe that a pollicized index finger will look and function better than a reconstructed small (hypoplastic) thumb. Importantly, this is not to say that all small thumbs should be excised- in reality most can be reconstructed and stabilized but need to have a stable base (CMC joint).
This case demonstrates a Type 3b hypoplastic thumb with an unstable CMC joint. Therefore, we did not feel that reconstruction made sense and we recommended pollicization.
|Small, hypoplastic thumb, without function, prior to pollicization|
|Pollicization, the creation of a new thumb|
|Another picture of pollicization. Note the new web space. |
The bruising disappears within a couple of weeks after surgery.