Pollicisation is a hand operation that creates a thumb from an existing finger, usually the index finger, by moving and rotating it into the thumb position. It mainly helps children born without a thumb or with a severely underdeveloped thumb, and some people who have lost the whole thumb through injury, to grasp and pinch.
- AnaesthesiaGeneral
- DurationTypically 2 to 4 hours
- Hospital stayUsually 1 to 3 days
- Back to routineCast for about 4 weeks; function develops over about 3 months
What is pollicisation?
The thumb is the most important digit for grasping and pinching. Pollicisation (also spelt pollicization) is a hand surgery technique in which a thumb is created from an existing finger, usually the index finger, which may be normal or injured. The finger is shortened, rotated and repositioned, with its own nerves, vessels and tendons, so it can work as a thumb.
It is most often performed in children with thumb aplasia (absent thumb) or severe thumb hypoplasia, and may also be used for other congenital hand differences such as macrodactyly, and for traumatic loss of the whole thumb. The approach substitutes a functioning finger for a deficient thumb, relying on both surgical technique and the brain's ability to adapt (plasticity), which is greatest in young children.
Who is pollicisation for?
- Children born without a thumb (thumb aplasia)
- Severe thumb hypoplasia, where the thumb is too underdeveloped to reconstruct
- Some other congenital hand differences, including macrodactyly
- Traumatic loss of the whole thumb, in selected cases
- Children who already use their index finger like a thumb are often good candidates
How is it done?
- Performed under general anaesthesia with a tourniquet to limit bleeding
- Incisions around the index finger; tendons and muscles are released while vessels and nerves are preserved
- The metacarpal growth plate is removed so the new thumb does not grow too long
- The finger is rotated and repositioned, fixed with fine wires and sutures, and tendons are rebalanced
- The skin is closed with absorbable stitches and the hand is placed in a cast
What is recovery like?
- Initial healing typically takes about 4 weeks in a cast
- Movement against resistance is usually started at around 8 weeks
- Useful function typically develops by about 12 weeks and continues to improve with use
- An occupational therapist may teach stretches and exercises
- Keep the wound dry and massage scars with petroleum jelly once healed
What are the risks?
- Problems with blood supply to the new thumb, rarely leading to tissue loss (necrosis)
- Scar contracture and joint stiffness
- Swelling (oedema)
- Nail deformity
- Cold intolerance and altered sensitivity
Why choose Dr. Jithendran?
- Dual training in orthopaedics (MS) and plastic surgery (MCh, DNB), with hand and microsurgery experience from Ganga Hospital, Coimbatore
- Consults at five hospitals across Bengaluru, with 24×7 availability for emergencies
- Clear explanations in English, Tamil, Hindi and Telugu, and time to answer every question
- Strict sterilisation and patient-privacy standards
Frequently asked questions
At what age is pollicisation usually done?
For children born without a functional thumb, pollicisation is commonly performed in early childhood, often around the first or second year of life, so the child learns to use the new thumb as hand skills develop. The best timing is decided by the surgeon based on the child's hand and general health.
Will the new thumb look and work like a normal thumb?
The new thumb is built from a finger, so it has three joints rather than two and looks somewhat different. Most children learn to use it for pinching and grasping, but strength and movement are usually less than a normal thumb. Therapy and everyday use help function improve over time.
Why is the index finger used?
The index finger sits next to the thumb position and has its own tendons, nerves and blood vessels, which can be moved with it. Using it creates a hand with four digits, including a thumb that can oppose the other fingers, which is generally more useful than five fingers without a thumb.
What care is needed after pollicisation?
The hand stays in a cast for about four weeks. After that, therapy exercises begin, with resistance movements around eight weeks. Scars are massaged with petroleum jelly, the wound is kept dry, and regular follow-up checks the thumb's position and growth.
