Radial Deficiency Small Thumb

Pollicization at 15 years

Pollicization, or the creation of a thumb from an index finger, is one of my favorite surgeries.  I like it so much because it allows me to accomplish my 2 primary goals for a child- making his or her hand function better and look better with a single operation.  I have written several blog entries on the topic:

I believe that the pollicization surgery requires a skill set that the surgeon develops only over time.  In other words, the surgeon must have a perfect understanding of the technical steps of the procedure (cut here, tighten there, etc.) but most also have a greater sense of how the new thumb should look and how to accomplish that goal.  To me, that skill takes time to develop.  While this is a whole other topic, the procedure is why I believe the mentorship model for education is so important for our field of congenital hand surgery.  All surgeons have spent years to finish medical school, residency, and fellowship (for orthopaedic surgeons, that process is 10 years) but I think more time still is required for the very specialized area of congenital hand surgery.  Undoubtedly, a surgeon who has completed his/ her training can recite the steps of the pollization procedure but, to me, more time is required and more experience is required before mastering the procedure.

I was fortunate to work with and learn from Paul Manske, one of the most accomplished congenital hand surgeons.  I learned from Dr Manske during my residency training and then had the good fortune to work with him for 10 years after I was done with my training.  I performed countless pollicizations with him and each time, I learned a little something.  But it was during that time that I felt my skill and confidence with this operation (and others) grow.

Anyway, back to the point of this post: the long term outcome of the pollicization.  These pictures demonstrate a very happy patient with a wonderful thumb, created 15 years ago by Dr Manske.  There is not really anything else for me to say other than this is a good outcome and one that we desire for every patient.  While not all pollicizations will look this good (there are many factors that affect the outcome), all, at least in my experience, improve both function and appearance of the hand.

Long term Pollicization.

Long term Pollicization, resting position

Long term Pollicization, pinch position.  Notice that there is nice tip to tip pinch.

Long term Pollicization from palm view.


  1. I started a support group a few years ago that seems to be one of a kind. There are many other support groups for limb difference, but this one is more specific to hypoplasia/aplasia with and without pollicization. My daughter, born in 2000, has bilateral hypoplastic thumbs. Her right hand had a pollicization in 2001, her left has had 3 reconstructive procedures in 2003, 2004 and 2015. Our group has over 250 members spanning the globe with ages ranging from infants (parents of infants actually) to adults and includes family and friends, as well. The adults in our group are thrilled to know that they are not the only ones with hands like theirs, as they thought they were. Well, actually everyone in the group is pretty happy to learn they are not alone. It’s a pretty cool thing to learn. I am hoping that someone can somehow share our group information and help others to know that they are not alone.

  2. interesting piece of information, I had come to know about your web-page from my friend pramod, jaipur,i have read atleast eight posts of yours by now, and let me tell you, your blog gives the best and the most interesting information. This is just the kind of information that i had been looking for, i'm already your rss reader now and i would regularly watch out for the new posts, once again hats off to you! Thanks a million once again, Regards Guidewire training in hyderabad

  3. Thank you for the question. I have performed a handful of pollicizations on teenagers with birth anomalies. I have also performed pollicizations on adults after trauma. I have not performed pollicization for a birth anomaly on an adult. Technically, it would a similar procedure (technically) but unless there were strong function reasons, I would lean against the procedure in an adult given the fact that the person has lived with a grown used to their status and function.

    The other part of your question relates to the big toe transplant vs the pollicization. I am a strong believer in pollicization for both function and appearance. I do NOT have the same confidence in the toe transplant procedure.

  4. Hello. Have you performed any pollicizations on adults who had their thumb amputated as a result of cancer? To have a full functioning hand again? Do you know where I can find pictures ? Is it called pollicization then ? I’m not sold on the great toe transfer. I just think there could be problems down the road, like can you have knee problems or hip problems or donor site morbidity. It would be nice having a thumb again though.

    1. Hello Roberta,

      Thank you for writing. I have performed adult pollicizations, most commonly related to traumatic amputations. While different from a politicization related to a birth anomaly, it can be a remarkable surgery. The primary goal is function which is critical as the thumb has been estimated to provide ~40% of hand function. Post cancer is somewhat different (but not completely different) from trauma and the soft tissue are critical to assuring a successful procedure. I was not able to find helpful pictures, unfortunately. Feel free to reach out off line at congenitalhand@wustl.edu

Leave a Reply

Your email address will not be published. Required fields are marked *