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Pollicization after traumatic amputation of the thumb
Clinical Orthopaedics and Related Research
|March 1, 1981
Summary
Pollicization in adults after traumatic thumb amputation yields satisfactory results with normal fingers but diminished motion with damaged ones. Preoperative imaging and pedicle flaps are recommended for optimal outcomes.
Area of Science:
- Orthopedic surgery
- Hand surgery
- Reconstructive surgery
Background:
- Thumb amputation due to trauma necessitates reconstructive options.
- Pollicization, a procedure to create a thumb from another digit, is a viable reconstructive strategy.
Observation:
- Nineteen adult patients underwent pollicization over 17 years following traumatic thumb amputation.
- Seven pollicizations used normal fingers, yielding very satisfactory results.
- Eleven pollicizations used previously damaged fingers, all resulting in diminished motion.
Findings:
- Preoperative arteriograms provide crucial information, especially when vascular damage is suspected.
- Utilizing a pedicle flap before pollicization is beneficial for cases with excessive scarring or inadequate skin cover, simplifying flap design and preventing web-space contractures.
- A significant majority of patients (74%) required secondary procedures, with tendolysis being the most common complication.
Implications:
- Pollicization is effective but outcomes vary based on the donor digit's condition.
- Preoperative vascular assessment and staged procedures (pedicle flap) can optimize surgical planning and results.
- The high rate of secondary procedures highlights the complexity and potential complications, necessitating careful patient selection and management.