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Hands
Published in Tor Wo Chiu, Stone’s Plastic Surgery Facts, 2018
When most of the metacarpal is missing, a whole thumb is needed. Options include the following: Pollicisation.Free toe–hand transfer offers the best reconstruction in a single operation, providing better sensation, stability and motor control (can expect good pinch and grasp) than the above; however, the patient’s age, motivation and functional requirements also need to be taken into account. It can be performed secondarily or acutely, including a wrap-around flap for salvage of avulsion injuries with most of the skeleton still remaining. It also has good growth potential in children.
Thumb deficiencies
Published in Benjamin Joseph, Selvadurai Nayagam, Randall Loder, Ian Torode, Paediatric Orthopaedics, 2016
Pollicisation is a simpler operation and the cosmetic appearance is better than after a microvascular joint transfer. The range of movement of the thumb is also greater following pollicisation.8
Injuries of the Hand
Published in Louis Solomon, David Warwick, Selvadurai Nayagam, Apley and Solomon's Concise System of Orthopaedics and Trauma, 2014
Louis Solomon, David Warwick, Selvadurai Nayagam
This should be dealt with by a team with special skills in hand surgery. In exceptional cases a new finger or thumb can be constructed by neurovascular microsurgical transfer of a toe, or a lost thumb can be replaced by rotating a surviving finger (pollicization) to restore oppositional movement.
Congenital thumb anomalies and the consequences for daily life: patients’ long-term experience after corrective surgery. A qualitative study
Published in Disability and Rehabilitation, 2018
I. K. Carlsson, L. B. Dahlin, H.-E. Rosberg
All participants were patients admitted to the Hand Surgery Clinic, Skane University Hospital, between the years 1978–1998 who could be interviewed (i.e. had no serious mental, cognitive and or linguistic impairments). Twenty-two patients were eligible for inclusion. Seven patients were not included as they declined participation due to lack of time or living too far away or could not be reached. The thumb duplications included were of the Wassel IV [8] and the thumb aplasia was Type IIIB, IV or V [9,10] and all had had previous surgery. Five of the patients with thumb hypoplasia had undergone a pollicisation procedure, two had tendon transfers and one had only removal of the rudimentary thumbs.[11] The patients with thumb duplication had surgery as described elsewhere for this type.[12]
Thumb reconstruction by “on-top-plasty” of the long finger
Published in Case Reports in Plastic Surgery and Hand Surgery, 2021
Mark A. Greyson, Sarah Kinsley, Simon G. Talbot
Transposition, or ‘on-top’ plasty, is a reliable, straightforward, and safe technique for thumb reconstruction, which crucially allows for native sensation. The technical details of this procedure are borne from the experiences of treating devastating hand trauma as well as congenital thumb absence, as many of same techniques and considerations are applicable to both ‘on-top-plasty’ and pollicization [14]. Pollicization is the cousin of the ‘on-top-plasty’, with the critical difference being that pollicization includes the transfer of all tendons and re-orientation of anatomic structures, which is often not achievable in the setting of mutilating hand trauma [13]. In both techniques, however, transposing the long finger to the thumb position has been described with relative paucity in the literature as compared to transposition or pollicization of the index finger. This technique was suggested initially by the French surgeon Guermonprez in 1887 and later refined by Tanzer and Littler in 1948 [7,15]. This reports highlights several critical steps specific to transposition of the long finger. First, ‘on-top-plasty’ with the long finger requires intraneural neurolysis and vascular dissection to the level of the palmar arch in order to reach the thumb position. Second, this case demonstrates that transfer of the long finger to the thumb position can be achieved with an ulnar neurovascular pedicle, which although described, is more technically challenging as it reduces the arc of rotation, and is employed only in the instance of injury to the radial digital artery [15]. Third, an important secondary maneuver in this operation is ray amputation of the residual index and/or long finger metacarpals in order to deepen an otherwise scarred or shallow first webspace, improving prehension. However, it is important not to excessively shorten the third metacarpal because the adductor pollicis originates on it. Therefore, metacarpal shortening of the long finger should only be performed to the extent required for a broad webspace that allows for adequate pinch.