Functional comparison between pollicization and toe-to-hand transfer for thumb reconstruction

The functional results of two methods of thumb reconstruction, pollicization, and toe transplantation were evaluated in four groups of patients: Group I, those missing the thumb but with four other normal digits; Group II, those missing the thumb with partially mutilated or amputated other digits; Group III, those with a metacarpal hand; and Group IV, those with a distal thumb amputation. In each group, results were compared in six categories: mobility, strength, sensibility, cosmetic appearance, pinch accuracy, and grasping power. In Group I, pollicization provided superior sensibility and mobility, but grasping power was best achieved by transfer of the big toe. Second toe transfer and pollicization both resulted in some weakness, compared with the normal hand. Pinch accuracy, related to the quality of sensibility, was better achieved by pollicization than by any free transfer. In Group II, although pollicization of a mutilated digit is more controversial, a very good functional level was reached in some cases, directly related to the amount of preoperative sensibility and the mobility of the proximal interphalangeal joint in the transferred digit. Reduction of strength and prehension depended on the number and quality of the remaining nontransferred digits. Toe transfer yielded better results in all six categories, as the severity of digit mutilation increased. In Group III, pollicization of the second metacarpal achieved a very rudimentary pinch, with toe transfer allowing for much greater prehension possibilities. In Group IV, distal thumb amputations were treated with distal digital pollicization as well as with partial toe transplantation. Both methods did well; however, indications for pollicization were extremely limited. Comparing results of big and second toe transfer for thumb reconstruction, big toe transfer achieved superior results, in both functional and cosmetic aspects.