18-01-02 composite ao and po pollicizationOur thumbs contribute to everything man-made. Without a thumb, hand function drops to 40% of normal. Three main reconstruction techniques are available to restore this critical part, either missing from birth or from injury. The first one, discussed last week, entails slowly lengthening the thumb remnant. I nickname it begging. This week’s post discusses the second method, which I call borrowing

Borrowing capitalizes on the fact that the index, middle, ring, and small fingers pretty much do the same thing, and losing one of these digits is not nearly as debilitating as losing a thumb. So, what can be done when the indispensable thumb is missing and  four underemployed friends are stationed nearby? Hmm. Borrow one? Yes!


Because of its proximity, the index finger usually gets the call, and its bone can be surgically shortened and rotated to make it thumb-like. The nerves, tendons, and blood vessels blissfully follow along. The surgery, however, is more complicated than rem­nant lengthening (begging), and it leaves a four-digit hand, which is not bad looking. (Remember: cartoon charac­ters all have four-digit hands.)

The advantages of borrowing for thumb reconstruction include that the new thumb has a nail and that the convalescence is short. The middle finger easily takes over the role of the index finger and can work with the thumb to manipulate buttons, pick up coins and paperclips, and manage a myriad of other common tasks

Next week: Thumb Reconstruction III: Stealing

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6 thoughts on “Thumb Reconstruction II: Borrowing

  1. The information about stealing a great toe from the foot to make a thumb sounds miraculous for the beneficiary and entertaining for the reader. That physicians, such as yourself are so skilled as to improve the lives of their patients in need of a thumb is inspiring.

  2. Great frame! Beg, borrow, or steal 🙂

    These reconstructed hands look amazingly “normal.” I remember rounding on a patient who had a thumb pollicization after a manufacturing accident and not noticing that she had an abnormal hand until the last day!

    1. Hi Emily,
      Right, our eye subconsciously seems to see overall contour and does not count number of digits. Years ago I had a patient who had a malignancy on her ring finger, and I advised removing the entire ring finger and its metacarpal bone and closing the space between her middle and small fingers. I told her that most people would not notice the absence. Some months after surgery, she told me that she had gone for a manicure, and at the end the patient asked the manicurist if she could have a discount. The manicurist asked, “Why?” She had not noticed that one finger was missing.
      Best wishes, Roy

  3. Thanks , I have just been searching for info about this subject
    for ages and yours is the greatest I have discovered so
    far. However, what in regards to the conclusion?
    Are you sure about the supply?

    1. HI Lee,
      I am glad I was able to enlighten you. I do not understand your question though. Which conclusion? What supply?
      Best wishes,

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