Background. Traumatic thumb amputation causes severe disability, impacting daily life and manual activities. In select cases, index finger pollicization offers a viable reconstructive option, especially for amputations proximal to the metacarpophalangeal (MCP) joint. This technique is particularly beneficial in avulsion injuries with tendon ruptures at the myotendinous junction (MTJ) and when microsurgical toe transfer is contraindicated or declined by the patient. This article describes our pollicization technique and reviews relevant literature from the last decade.
Methods. We present two cases managed with index finger pollicization. The first involved a 49-year-old farmer with a dominant-hand thumb avulsion at the MCP joint, with neurovascular damage and tendon tears at the MTJ, making replantation infeasible. The second case was a 61-year-old heavy smoker with similar thumb avulsion injuries, where pollicization was performed following a failed replantation attempt.
Results. Both patients recovered without postoperative complications. The reconstructed thumbs achieved sensitivity, abduction, adduction, and opposition, with limited flexion and extension. These functions allowed effective pinching and gripping, and neither patient required secondary tendon adjustments. Both returned to work, satisfied with the aesthetic and functional outcomes.
Conclusions. Index finger pollicization is a critical technique that hand surgeons should consider as an alternative when microsurgical reconstruction is not feasible or is declined. This approach enables functional thumb restoration, making it a valuable option for complex thumb injuries.
