Traumatized Index Finger Ray Pollicization Accompanied with Various Reconstructive Procedures for Post-traumatic Thumb Loss Proximal to Metacarpophalangeal Joint

Abstract

Purpose: In the situation of thumb amputations proximal to metacarpophalangeal joints or extensive composite first ray defect, toe transfer may has the limitation of adequate functional length reconstruction Pollicization will be an alternative. Materials and Methods: Seven patients underwent index finger pollicization for their thumb loss proximal to the metacarpophalangeal joint level. While three were reconstructed at chronic stage (7, 13, 15 months) after previous primary surgeries with inadequate basic hand functional restoration, four patient received pollicization at acute stage (within 1 week). Several tendon transfers including opponensplasty, intrincis tendon reconstruction were performed simultaneously. Four free flaps (3 anterolateral thigh flaps, 1 fibular flap) were transferred in acute reconstruction, and 2 local flaps and 1 groin flap in chronic stage reconstruction. Thee of four acute reconstruction require index finger revascularization during pollicization. Results: One revascularized index ray failed and was lost. The other six patients achieved a basic hand functional reconstruction and have adequate opposition as Kapandji categories 5-8, abduction angle 58.3 degrees (40-80), and circumduction angle 103.3 degrees (90-110) to allow prehensile integration between the neo-thumb and 2-5th fingers. The tripod pinch was around 20% of the contralateral hand. Conclusion: With the application of microsurgical technique and tendon transfers, pollicization using a traumatized and functional impaired index finger is a good alternative option for thumb loss proximal to MPJ, especially in the situation when toe-to-thumb transfer can not provide an adequate functional restoration.