This is a retrospective review of 8 cases of pollicization of the index finger for treatment of thumb loss. Seven patients had traumatic amputation of the thumb, and 1 patient was treated for malignancy with thumb amputation. All patients were adults, 24-66 years of age. The level of amputation was from the CMC joint to the base of the proximal phalanx in all cases. Either a Littler transfer or a Buck-Gramcko procedure was used, depending on the level of amputation, with the Buck-Gramcko being reserved for CMC joint amputation. In all cases the index metacarpal was rotated 160 into pronation at the time of osteosynthesis to reproduce a more natural thumb posture and better opposition. Standard flexor, extensor, and intrinsic repairs were utilized. The authors reviewed range of motion, opposition and pinch strength, sensation, position sense conversion, function via a picking up test, and appearance. There were no complications in the series. Average follow-up was 15 years (5-28 years). Functional results were adequate, with one patient failing to obtain mobility in the MCP and IP joints and the remainder with 38 and 23 degrees active motion at those joints, respectively. Pinch and opposition were restored in all patients. Grip and pinch strength averaged 69 and 41 percent of the contralateral hand, respectively. All patients were either satisfied or very satisfied.
This excellent review shows that index finger pollicization remains a viable and successful option for treatment of the amputated thumb. The authors state that the indication is amputation proximal to the base of the proximal phalanx. More distal amputations are treated with wrap-around flaps or toe-to-thumb transfers. The results support the utility of this procedure for appropriate indications, even in cases with little active motion at the MCP and IP joints. Sensation is generally preserved, which is an advantage over microsurgical transfers. However, the loss of an uninjured digit in a hand with severe deficits from thumb amputation remains a significant concern, and microsurgical transfers remain the procedures of choice for more distal levels.
Thumb, Amputation, Pollicization, Index
J Reconstructive Microsurgery