Pollicization is the surgical technique performed to reconstruct the thumb from other existing fingers when there is no thumb or thumb hypoplasia
Principles of Pollicization
Traumatic and congenital absence of thumb causes a severe deficiency in hand function; such absence usually is considered as the absence of thumb signifies 40% disability of hand as a whole
When the thumb is partially/ totally absent, the function of the hand can be improved by a carefully planned and skillful execution operation, esp. in young patients
For Pollicisiation following factors must be considered:
- Length of the remaining part of the thumb
- Condition of rest of hand
- Age of patient
- Occupational requirements of the patient
- Knowledge and experience of the surgeon
Usually, the thumb is reconstructed when amputation is at MCP joint or more proximal to it
When the MCP joint or useful segment of proximal phalanx remains, the only surgery necessary for politicization is the deepening of the thumb by Z-plasty.
When amputation has been through the IP joint, the distal phalanx, or the pulp of the thumb, only appropriate coverage by the skin is necessary, unless sensibility in the area of pinch is grossly impaired, neurovascular island transfer may be indicated
If the opposite thumb is Normal the reconstruction/ pollicization is not mandatory
In pollicization the metacarpal head becomes the new trapezium
Requirements for Pollicization
Sensibility
Although not necessarily normal, should be painless and sufficient for recognition of object held in a position of pinch
Stability
As that pinch pressure does not cause the thumb joint to deviate or collapse or cause the skin pad to shift
Sufficient mobility
Enable the hand to flatten and the thumb to oppose for pinch
Sufficient length
Enable opposite digit to touch by thumb
Cosmetically acceptable
Some Important Points on Pollicization and Microsurgery
Nakayama (1964): Free tissue transfer
Komatsu and Tamai (1965): Thump Reimplantation
Cobbett (1968): Free greater toe-to-hand transfer
McLean and Buncke (1969): First free omentum flap
In Older patients with traumatic amputation of the thumb, surgery differs for the young children in congenital absence is in the older patient it is necessary to shorten the flexor tendons however in children at the age of 6 months only the extensor mechanism needs to be tightened.
