PRIMARY
POLLICISATION
OF
J. G. SALLIS,
From
man
A
aged
fifty
PORT
his
The
index
finger
had
head
with
been
left
through
of the dorsal
skin
The metacarpo-phalangeal
phalanx.
The extensor
joint
digitorum
injury.
middle
distal
and
the
overlying
AFRICA
England
hand
proximal
in a spinning
part
ofthe
was completely
communis
machine
to
the
shaft
of the
phalanx
phalanx
disrupted
tendon
was
distal
of the
proximal
the proximal
phalanges,
FINGER
(Fig.
1).
of the hand was as follows.
of the proximal
phalanx.
remained
but was not viable.
had a compound
fracture-dislocation
avulsion
The
London,
non-dominant
severed
MIDDLE
SOUTH
Hospital,
At the time of primary
operation
the condition
The thumb
had been severed
through
the base
the palmar
skin
The middlefinger
INJURED
ELIZABETH,
St George’s
mangled
AN
and
metacarpal;
and
part
metacarpal
of the metacarpal.
with comminution
of the proximal
severed
and contused
at the site of
compound
fracture-dislocation,
were
uninjured
with both
the neurovascular
bundles
intact
and with skin of normal
colour
and
sensation.
The flexor
mechanism
on the volar
aspect
of the finger was contused.
The ring finger
had a traumatic
amputation
through
the distal
part of the proximal
phalanx
with an adequate
The littlefinger
volar flap of skin
had been amputated
Operation-The
cleaned
The
was
taken
direct
closure.
the middle
phalanx.
to the
theatre
using
Cetavlon,
ether
and saline.
The non-viable
palmar
skin was trimmed
fingers
was
patient
to effect
through
were
closed,
resected
just
Both
the
base
of the
proximal
using
the
distal
to
available
its
base
neurovascular
and
bundles
middle
phalanx
palmar
phalanx
the
of the middle
finger were passed
out at the site of the amputation
; the
amputation
The
were
through
of the
resected.
a tunnel,
thumb.
cut
best
position
been
cut
of rotation
during
Dry,
the
voluminous
below-elbow
Progress
after
embarrassment,
twelve
hours
a stellate
immediate
The
looked
Theviable
A
with
sent
for
VOL.
45 B,
re-education
NO.
3,
was
grey
became
kept
hand
elevated;
back
into
fascia,
remnant
palm.
head,
phalanges
and were brought
was fixed to the
The
arm
the
distal
wire (Fig. 2). At
when attempting
and
little
finger
metacarpal
middleand
antibiotic
of the
all times
to obtain
the
the
tendon
had
flexor
were
immobilised
pollicised
eschar
therapy
was
in a
middle
continued
finger
showed
in colour
but still blanched
to pressure.
worse
with no blanching
on pressure
and,
formed
at
the
top
hours
with
of
the
after
operation.
blanching.
pollicised
Over
because
This
finger
and
signs
the next
of this,
There
was
improvement
which
of
an
separated
epithelialisation.
stumps
healed
without
on removing
the sutures
active
and
AUGUST
the
and
was done
about
eighteen
in the colour
of the “thumb,”
complete
weeks
done.
and
index
slab.
hand
small
amputation
excellent
and
four
applied
was
was
stump.
The
embarrassment.
repair
for five days.
operation
the circulation
ganglion
block
improvement
After
were
operation-The
maintained.
tendon
the
hand
ring
of the
dissected
deep to the palmar
This middle
finger
in circulatory
no
plaster-of-Paris
and became
the circulation
spontaneously
resulted
and
dressings
volar
Chymar
was prescribed
Five hours
after
was
; this
transfer
of the
across.
base of the proximal
phalanx
of the thumb
by a Kirschner
circulation
of the pollicised
middle
finger
was adequate
except
The
stump
to close
were
was
injury.
stumps
used
finger
finger
the
metacarpal
skin
middle
middle
and interphalangealjoint
after
skin.
palmar
of the
of the
six hours
movements
rehabilitation.
1963
and
Over
incident.
Two weeks
the wound
had healed.
later
the
exercises
started,
and
later
the
months
the
bone
united
the
were
next
few
pollicised
finger
patient
(Fig.
was
3).
503
504
J. G. SALLIS
Figure
I-The
middle
finger to the thumb.
hand
time of injury.
Figure 2-The
Kirschner
wire in position,
after transferring
the
Figure 3-The
remaining
part of the proximal phalanx of the thumb and part of
the middle phalanx
of the middle finger have united.
at the
4’)
_
The
Function
meet
gradually
the
improved;
stumps
of the
the
little
and
pollicised
ring
FIG.
4
end
result.
could
be brought
into opposition
to
Power
and grip of the hand were good.
“thumb”
fingers
(Fig.
4).
Sensation
was normal
but the patiellt
occasionally
felt the “thumb”
as his middle
finger.
He was eminently
satisfied
with the result
and returned
to manual
labour
using a spade;
but
he could
not return
to his previous
employment
in charge
of a spinning
machine.
DISCUSSION
The
been
finger
used.
however,
Littler
agree
(1887),
blood
any
(1925),
ganglion
supply
of the
used
advised
injured
Pollicisation
Jepson
Stellate
commonly
(1953)
that
hand.
injured
the
most
using
digit
of the
Tanzer
block
and
seemed
transferred
for
should
injured
Littler
at the
is the
pollicisation
the
index
finger
be used
middle
(1948)
time
index
as
the
if pollicisation
finger
and
has
been
Hilgenfeldt
to be an essential
finger.
first
The
little
choice.
is indicated
described
finger
Most
authors,
in the
severely
has
by Guermonprez
(1950).
step
in the
preservation
of
finger.
THE
JOURNAL
OF
BONE
AND
JOINT
SURGERY
PRIMARY
The
result
POLLICISATION
obtained
with
this
OF AN
patient
INJURED
MIDDLE
is satisfactory
505
FINGER
functionally
although
it could
be
by flexor and extensor
tendon
grafting
and rotation
osteotomy
through
the proximal
phalanx
to improve
opposition.
Resection
of more of the shaft of the third
metacarpal
would
also increase
the cleft between
the thumb
and opposing
stumps.
However,
the patient
is
satisfied
with the result
and does not want further
operations.
enhanced
SUMMARY
I.
Primary
2.
The
I wish
pollicisation
value
to thank
publish
this
of an injured
of stellate
Mr
case;
ganglion
Goronwy
Mr
Thomas
I. Kaplan,
middle
block
of the
formerly
and now of Johannesburg,
for his helpful
Surgeons of England for the photographs.
finger
in preserving
David
Lewis
is described.
the
blood
Northern
supply
Hospital,
is emphasised.
Liverpool,
for allowing
me to
of the Plastic
Surgery
Department,
Pittsburgh
Medical
School,
criticism
of the paper;
and Mr C. Redman
of the Royal College
of
REFERENCES
F. (1887):
du pouce.
Paris: P. Asselin.
(1950):
Operatii’er
Daumenersatz
und Beseitigung
ion
Greifstorungen
bei Fingerverlusi’en.
Stuttgart:
Ferdinand
Enke.
JEPSON,
P. N. (1925): Transformation
of the Middle
Finger
into a Thumb.
Minnesota
Medicine,
8, 552.
LITTLER,
J. W. (1953):
The Neurovascular
Pedicle
Method
of Digital
Transposition
for Reconstruction
of the
Thumb.
Plastic and Reconstructive
Surgery,
12, 303.
GUERMONPREZ,
R. C., and
Plastic
VOL.
sur quelques
r#{233}sections et restaurations
0.
H1LGENFELDT,
TANZER,
Notes
45 B,
and
NO.
LITTLER,
Reconstructii’e
3,
AUGUST
J. W.
(1948):
Surgery,
1963
Reconstruction
3, 533.
of the Thumb
by Transposition
of an Adjacent
Digit.