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

Abstract

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.

Evaluación funcional posterior a la pulgarización en hipoplasia de pulgar mediante uso de T-GAP score

“…Buck-Gramcko, quien tiene la mayor experiencia con malformaciones de las manos debido a la talidomida-embriopatía a finales de los años 60, mejoró la técnica quirúrgica. 10 Al crear un nuevo pulgar a partir del dedo índice, los siguientes puntos son los fundamentos para el éxito que lleva a un pulgar funcional a: (a) corregir la incisión de la piel, (b) optimizar la posición, (c) reducir la longitud de los huesos, (d) estabilidad de la nueva articulación.…”

Index Finger Pollicization Incisions for Congenital Thumb Aplasia: Review and Design of an Educational Anatomical Model for Skin Incisions

“…Vekris et al 11 used the Buck-Gramcko incisions in 21 patients and judged the appearance of the new thumb satisfactory for all parents except in one case also according to Percival et al 12 criteria. Hildegunde et al 13 used the Buck-Gramcko incisions in their series of 19 hands with satisfactory results also according to the criteria described by Percival et al According to them, the dorsal scars are not a cosmetic issue and they did not recommend the Foucher incisions. Plastic and Reconstructive Surgery • August 2021 Manske 14 described incisions that seems to be inspired by Buck-Gramcko's original description.…”