POLLICISATION

Pollicisation is the process of forming a thumb from the other fingers of the hand to replace the missing thumb. It is mostly applied because of loss due to trauma or congenital absence. Among the congenital anomalies, the most frequently pollicized condition is the developmental deficiency of the thumb (thumb hypoplasia) and the absence (or instability) of the joint between the metacarpal and the wrist bone (trapezium) below it. Apart from this, the giant thumb (macrodactyly), Congenital multi-finger and Mirror hand deformity are other congenital anomalies in which pollicisation treatment may be applied. After the pollicisation surgery, cortical plasticity, that is, the acceptance of the new finger as a thumb by the brain will be possible with the sprouting branches that will be sent by neurons (nerve cells) in the brain from the brain regions adjacent to the area where the thumb is represented. 1-1.5 years of age is the most accurate timing for pollicisation surgery in congenital anomalies and, as soon as possible after loss in traumatic cases. Thus, it will be possible to both experience the deficiency for the least amount of time and learn how to use of the new thumb.

The index finger is mostly used for pollicisation. Rarely, if both the thumb and index finger are absent and the current situation does not allow toe transfer to hand, then the middle finger can be pollicized as well. The finger to be used for transfer must not be affected by the existing anomaly or trauma. The transfer is performed by preserving all the structures of the finger to be pollicised. Preservation of arteries and veins is critical for the vitality of this finger. Sensory nerves, flexor and extensor tendons of the finger should also be properly protected in order to function after transfer. In normal hand structure, the thumb consists of two and the other fingers consist of three phalanges. In order for the transfered finger to adapt both visually and functionally, the metatarsal bone of the transfered finger is shortened appropriately and bone fixation is achieved in this way. The fixation of the bone, which is shaped by shortening and rotated a little, is made by means of surgical wires, one part of which is left out of the tissue. When it is seen that the reshaped bone is fused in the X-rays taken at the end of 4-6 weeks, the wires are removed during the dressing with a simple procedure.

Physiotherapy, which comes to the agenda after the completion of the surgical and post-surgical wound care process, has a critical importance as it is after most operations of hand surgery. The use of the new thumb as much as possible should be supported by play therapy methods in children and rehabilitation techniques in adults. With the increase in the use of the new thumb, the adaptation of the brain increases, as the brain adaptation increases, the patient can use his hand for finer Works more.

The most common complications after pollicisation are; The development of contracture between the new thumb and 2nd finger, the inadequacy of the tip-to-pulp touch of the thumb and the other fingers, which we call opposition, and rotation defects (malrotation) in the thumb. However, most of these problems can be overcome by secondary surgeries.

The thumb is responsible for about 40% of hand functions. Therefore, if it is not properly remedied in case of its deficiency or loss, it will result in a serious inability to use of the hand. Since the aim here is to provide a functional well-being rather than improving the appearance, pollicisation is one of the most accurate approaches in cases of loss and birth problems mentioned above.