Pollicization of the index finger in hypoplasia of the thumb. Experience with the method of Buck-Gramcko and retrospective analysis of the clinical outcome in a series of 19 pollicizations

Abstract

Background

In congenital malformation of the thumb index finger pollicization is a proven method for constructing a new thumb all over the world.

Methods

A series of 19 pollicizations in 15 patients is presented. In all cases of index finger pollicization the method of Buck-Gramcko is used and the functional outcome is evaluated after Percival’s method. Three special cases are described in detail and the preoperative evaluation with a CT-angiography in cases of complex malformations (case 3) for better planning of the surgical steps is recommended. The importance of parent’s information soon after giving birth to a child with thumb hypoplasia is described in detail as the postoperative management.

Results

In children with bilateral deformities of the hand the surgery can be performed in one session, in only 2 cases a second operation was necessary. The postoperative results were excellent and good (Percival’s measurement) and the children are now able to perfectly use their affected hand in their day-to-day activities.

Conclusion

Buck-Gramcko’s method of pollicization in congenital thumb malformation gives excellent results. The preoperative planning and exactly following the four key steps is as important as the postoperative management.

Keywords

Congenital thumb hypoplasia - Pollicization - Functional result - CT-angiography

• References

• 1 Buck-Gramcko D. Operativer Daumenersatz bei Aplasie und Hypoplasie. Beilage Z Orthop 1969; 105: 417-421
• 2 Foucher G, Medina J, Loréa P, Pivato G, Szabo Z. Pollicization in congenital differences. Handchir Mikrochir Plast Chir 2004; 36: 146-151
• 3 Lister G. Reconstruction of the hypoplastic thumb. Clin Orthop Relat Res 1985; 195: 52-65
• 4 Buck-Gramcko D. Pollicization of the index finger: method and results in aplasia and hypoplasia of the thumb. J Bone Joint Surg 1971; 53A: 1605-1617
• 5 Buck-Gramcko D. Pollicization congenital malformations of the hand and forearm. Churchill Livingstone 1998;
• 6 Müller W. Die angeborenen Fehlbildungen der menschlichen Hand. Thieme Leipzig 1937;
• 7 Blauth W. Der hypoplastische Daumen. Arch Orthop Unfallchir 1967; 62: 225-246
• 8 Nishijima N, Matsumoto T, Ymamuro T. Two stage reconstruction for the hypoplastic thumb. J Hand Surg 1995; 20A: 415-419
• 9 Shibata M, Yoshizu T, Seki T, Goto M, Saito H, Tajima T. Reconstruction of a congenital hypoplastic thumb with use of a free vascularized metatarsophalangeal Joint. J Bone Joint Surg 1998; 80A: 1469-1476
• 10 Gosset J. La Pollicisation de L’index (technique chirurgicale). J Chir (Paris) 1949; 65: 403-411
• 11 Hilgenfeld O. Operativer Daumenersatz und Beseitigung von Greifstorungen bei Fingerverlusten. Enke Stuttgart 1950;
• 12 Littler JW. The neurovascular pedicle method of digital transposition for reconstruction of the thumb. Plast Reconstr Surg 1953; 12: 303-319
• 13 Aliu O, Netscher DT, Staines KG. A 5-year interval evaluation of function after pollicization for congenital thumb aplasia using multiple outcome measures. Plast Reconstr Surg 2008; 122: 198-205
• 14 Foucher G, Medina J. Principalization of pollicization of the index finger in congenital absence of the thumb. Tech Hand Up Extrem Surg 2005; 9: 96-104
• 15 Percival NJ, Sykes PJ, Chandraprakasam T. A method of assessment of pollicization. J Hand Surg 1991; 16B: 141-143
• 16 Staines KG, Majzoub R, Thornby J, Netscher DT. Functional outcome for children with thumb aplasia undergoing pollicization. Plast Reconstr Surg 2005; 116: 1314-132
• 17 Hostin R, James MA. Reconstruction of the Hypoplastic Thumb. Am Soc Surg Hand 2004; 4: 275-290
• 18 Foucher G, Medina J, Navarro R, Nagel D. Toe transfer in congenital hand malformations. J Reconstr Microsurg 2001; 17: 1-7
• 19 O’Brian BM, Black JM, Morrison WA, MacLeod AM. Microvascular great toe transfer for congenital absence of the thumb. Hand 1978; 10: 113-124
• 20 Abdel-Ghani H, Amro S. Characteristics of patients with hypoplastic thumb: a prospective study of 51 patients with the results of surgical treatment. J Pediatr Orthop 2004; B13: 127-138
• 21 Goldfarb CA, Deardorff V, Chia B, Meander A, Manske PR. Objective features and aesthetic outcome of pol-licised digits compared with normal thumbs. J Hand Surg 2007; 32A: 1031-1036
• 22 Lorea P, Medina J, Navarro R, Foucher G. Princi-palisation of pollicization in congenital conditions. Technical modifications for functional and aesthetic improvement. Chir Main 2008; 27 ((Suppl 1)) 540-547
• 23 Klein MB, Karanas YL, Chow LC, Rubin GD, Chang J. Early experience with computed tomographic angiography in microsurgical reconstruction. Plast Reconstr Surg 2003; 112: 498-503