April 11, 2024

Pollicization is the surgical technique performed to reconstruct the thumb from other existing fingers when there is no thumb or thumb hypoplasia

Pollicization

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.