Pollicization of the index finger in hypoplasia of the thumb. Experience with the method of Buck-Gramcko and retrospective analysis of the clinical outcome in a series of 19 pollicizations.

BACKGROUND: In congenital malformation of the thumb index finger pollicization is a proven method for constructing a new thumb all over the world.
METHODS: A series of 19 pollicizations in 15 patients is presented. In all cases of index finger pollicization the method of Buck-Gramcko is used and the functional outcome is evaluated after Percival's method. Three special cases are described in detail and the preoperative evaluation with a CT-angiography in cases of complex malformations (case 3) for better planning of the surgical steps is recommended. The importance of parent's information soon after giving birth to a child with thumb hypoplasia is described in detail as the postoperative management.
RESULTS: In children with bilateral deformities of the hand the surgery can be performed in one session, in only 2 cases a second operation was necessary. The postoperative results were excellent and good (Percival's measurement) and the children are now able to perfectly use their affected hand in their day-to-day activities.
CONCLUSION: Buck-Gramcko's method of pollicization in congenital thumb malformation gives excellent results. The preoperative planning and exactly following the four key steps is as important as the postoperative management.