This is the transfer of the index finger to the position of the thumb. The finger is not removed, but rather rotated and brought down into the thumb position. This includes shifting of the whole finger with its skin, fingernail, bone, joints, blood vessels and nerves from one position in the hand to the thumb position.

Canididates for the Procedure:-

  • A child born with an underdeveloped or non-functioning thumb.
  • A child born without a thumb.
  • A child who has an appropriate finger to shift into the thumb position.

Benefits from the Surgery


Many parents are concerned with the way their child will look following the surgery with three fingers and a thumb instead of four fingers. The presence of the pollicized thumb make the hand look more natural and less noticeable than four fingers and a small non-functional or absent thumb.


The most important thing that the pollicized thumb does is to allow the child to pick up large objects. It also provides a child with the ability to explore, manipulate and control objects of various weights and sizes. A thumb helps improve use the use of the hand for the activities of daily living such as buttoning clothing.

Children without a thumb develop a scissors grasp between adjacent fingers, usually the index and middle fingers. This scissors grasp can be awkward and weak because they have nothing to oppose their fingers against. This reduces the use of the hand.

Surgery and the Hand Surgeon's Goals

The hand surgeon trys to obtain the following goals through this surgery:-

  • To improve the function of the hand for grasping large objects
  • To improve the effectiveness for precision pinch and the ability to handle small objects with a thumb finger grasp pattern
  • To give the "pollicized finger" the appearance of a thumb

When the index finger is shifted into the thumb position, the hand surgeon takes great care to reduce the size of the scars. He attempts to place them towards the palm of the hand, in the web space, and at the base of the thumb. Your child's healing characteristics will determine how noticeable the scars will be on his hand.

This operation lasts about three hours. Your child will be sent to recovery with his whole arm will be placed in a plaster splint covered with bandages and an ace wrap.

After Surgery Following the surgery, your child will wear the plaster splint for about four to six weeks. During this time, your child will be allowed to return home, attend day care, or to go to school.

At four to six weeks following the surgery, your child needs to be re-admitted to the hospital for removal of the splint and for occupational therapy. At this time, the new thumb will be held in its position with tape or a plastic splint. Through exercises and activities, the occupational therapist will assist your child in learning how to use their new thumb.

Other Surgeries It is possible that other surgeries will be needed but this depends upon your child's diagnosis and function of the hand following the pollicization procedure. The diagnosis of a radial club hand or previous centralization appears to influence the need for other surgeries.

A surgery that may be needed after the pollicization operation is an oppenesplasty. This is the transfer of the muscle along the little finger side of the hand to the pollicized thumb to give it more rotation and strength and an improved ability to grasp objects tighter.

An operation to tighten the tendon that extends the thumb may be needed. In some children, it may be useful to fuse [make stiff] the joint in the thumb, if that would help the child's functioning. The doctor or therapist will discuss with you of your child needs any of these surgeries.