Pollicization of index finger after traumatic thumb amputation

Summary Objectives Reconstruction of a functionally and esthetically satisfying thumb by pollicization of the index finger. Indications Isolated amputation of the thumb at the level of the metacarpophalangeal joint or at the level of metacarpal. Isolated amputation of the thumb at the level of the base of the proximal phalanx as an alternative to a toe transplantation. Contraindications Deficient circulation in the index or middle finger. Surgical Technique Incision around the index finger at the level of the proximal phalanx and formation of a skin flap with a palmar base. Dissection of the stump of the thumb and osteotomy of the metacarpal. Dissection and mobilization of veins and nerve branches at the extensor side, proximal transection of the extensor tendons of the index finger. Dissection of nerves and vessels at the flexor side. Interfascicular splitting of the common palmar nerve II/III. Division of the radial artery of the middle finger between 2 ligatures. Opening of the flexor tendon sheath up to the mid part of the proximal phalanx. Osteotomy of the proximal phalanx of the index finger. Transposition of the index finger maintaining the continuity of flexor tendons, palmar nerves, ulnar digital artery and posterior nerves and veins. Internal fixation between first metacarpal and proximal phalanx of index finger, sutures uniting the extensor tendons of the thumb and extensor tendons of index finger. The lateral bands of the extensor aponeurosis are woven into the short muscles of the thumb. Skin closure. Results We observed in 19 patients undergoing this surgical technique 1 intraoperative injury to the neurovascular bundle and 1 instance of necrosis of wound edges; all other patients healed without complications. In 17 patients followed up for an average of 5.4 years the average mobility of the metacarpophalangeal joint was 21° and of the interphalangeal joint 24°. Fifteen of the 17 patients were able to perform a pinch. Sensitivity was preserved in all patients. The average distance of the 2-point discrimination was 9 mm, 1 patient had no 2-point discrimination.