10/02/2025
Would you believe that thumb is made out of a toe? Swipe for a video of the motion for this little boy. I am so thrilled for him and his family. He had two surgeries to get to this point. I’ve showed you cases before where I move an index finger to make a thumb for patients who are born without one, or who are born with very underdeveloped thumbs. Not every family is willing to have that surgery. For those patients I can remove a toe bone to help stabilize their underdeveloped thumbs. This surgery only provides support for their finger, it does not recreate any of the muscles or ligaments that are important for thumb motion. So that means that they need to have more surgery later to help make the thumb move. And that is exactly what I did for this young boy. His parents did not want a pollicization (moving the index finger) and so instead I used his toe bone to reconstruct his thumb (you can swipe to see the X-rays showing how this looks, and how the foot looks now too!) After he healed we did the next surgery, called an opponensplasty, to help give his thumb more motion. This operation borrows an extra tendon from the ring finger, and you can look through my old posts to see some videos of how that looks. I also changed the shape of the space between his index finger and thumb to make it easier for him to grab things. In the future I will transfer some fat from other parts of his body to improve the shape of the thumb. For those in the know: to honor cultural preferences and still provide the best opportunity for function for my patients, I will perform free non-vascular 4th metatarsal transfer for patients under 4, and free vascularized 2nd toe MTPJ transfer for older children (l’ve posted a case of this before.) A pollicization is without a doubt the superior functional surgery, and achieves reconstruction in a single stage as opposed to multiple steps, however not all families choose it.
