Pollicization

Pollicization is a surgical procedure used to create or reconstruct a functional thumb. This procedure is often performed in cases where the thumb is absent or non-functional due to congenital defects, trauma, or disease. Pollicization involves the transformation of a finger, usually the index finger, into a thumb. The process is complex and requires careful consideration of the biomechanics of the hand to ensure that the newly created thumb is functional, has adequate mobility, and can perform the wide range of motions that a natural thumb can.

Indications

Pollicization is indicated in several conditions, including but not limited to:

• Congenital anomalies such as Radial dysplasia, where the radius bone in the forearm is underdeveloped or absent, leading to a deficiency or absence of the thumb.
• Loss of thumb due to trauma or surgical amputation.
• Severe functional impairments where the thumb cannot perform its gripping and pinching functions.

Procedure

The pollicization procedure involves several key steps:

1. Selection of the donor finger, usually the index finger, based on its size, length, and the patient's hand anatomy.
2. Detachment of the selected finger at its base, taking care to preserve the nerves, blood vessels, and tendons.
3. Rotation and repositioning of the finger to mimic the position and orientation of a thumb.
4. Reattachment of the nerves, blood vessels, and tendons to ensure adequate blood flow and functionality of the newly created thumb.
5. Skin closure and dressing to promote healing.

Recovery and Rehabilitation

Post-surgery, patients undergo a period of rehabilitation that includes physical therapy and exercises to improve the function, strength, and range of motion of the new thumb. The success of pollicization significantly depends on the post-operative rehabilitation process.

Outcomes

Patients who undergo pollicization often experience improved hand function, enabling them to perform tasks that require thumb opposition, such as gripping and pinching. The aesthetic outcomes of the surgery can also positively impact the patient's self-esteem and psychological well-being.

Risks and Complications

As with any surgical procedure, pollicization carries risks such as infection, bleeding, and adverse reactions to anesthesia. Specific to pollicization, there is a risk of reduced sensation in the new thumb, limited range of motion, or failure to achieve the desired functional or aesthetic outcomes.