Traumatized Index Finger Pollicization for Thumb Reconstruction

• Published in: The Journal of hand surgery (American ed.) Vol. 33; no. 2; pp. 257 - 262
• Main Authors: Bravo, César J., MD, Horton, Todd, MD, Moran, Steven L., MD, Shin, Alexander Y., MD
• Format: Journal Article
• Language: English
• Published: New york, NY Elsevier Inc 01-02-2008; Elsevier
• Subjects: Adult; Aged; Amputation, Traumatic; Biological and medical sciences; Finger Injuries - surgery; Fingers - transplantation; Follow-Up Studies; Hand Strength; Humans; Index finger; Male; Medical sciences; Middle Aged; on-top plasty; Orthopedic surgery; Orthopedics; pollicization; Range of Motion, Articular; Retrospective Studies; Sensation; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Thumb - injuries; Thumb - surgery; thumb reconstruction; thumb reconstruction; on-top plasty; pollicization; Index finger; Plasty; Treatment; Thumb; Anatomical reconstruction; Pollicization; Index (finger)
• ISSN: 0363-5023; 1531-6564
• DOI: 10.1016/j.jhsa.2007.11.008

Purpose When the index finger is injured or severed in conjunction with a traumatic amputation of the thumb, transfer of the injured index finger can restore the important function of the thumb. The purpose of this study is to evaluate the results of the transfer of an injured index finger for traumatic loss of the thumb. Methods Seven patients treated by pedicled transfer of a traumatized index finger after amputation to the ipsilateral thumb were reviewed retrospectively. Postoperative evaluations included thumb range of motion, opposition and pinch function, grasp and pinch strength, sensation, a pick-up test, and a patient-rated appearance of the thumb and hand. Vascular patency of the traumatized index finger and thumb was evaluated in each patient prior to thumb reconstruction. Results After an average of 4 years of follow-up for surviving patients, all had excellent postoperative function and satisfactory results. The period between injury and thumb reconstruction ranged from 5 months to 4 years. All patients were men with a mean age of 43 years. Amputation levels included the metacarpophalangeal joint in 2 patients, the first metacarpal in 2 patients, and the proximal phalanx in 3 patients. All transferred traumatic index fingers survived without complications. Conclusions Transfer of the injured index finger to the amputated thumb serves as an excellent adjunct for treatment of traumatic thumb amputations/crush injuries. Consistent results can be obtained while maintaining opposition and protective sensation after this procedure. However, technical demands are great, and initial injuries to the thumb and index finger ultimately determine the final outcomes. Type of study/level of evidence Therapeutic IV.