ABSTRACT
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 mutiliated 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.
