Thumb Surgery: How Hand Surgeons Can Build a Thumb

I make thumbs. I’m not talking about two thumbs up, thumbing your nose at someone, or any other thumb-related expression here. I’m talking about actually creating a thumb for babies born without one.

Several times each year, I see babies born with no thumb (thumb aplasia), or with thumbs that don’t work or look like a typical thumb (thumb hypoplasia). As a hand surgeon who works specifically on kid-specific hand and arm issues, I get the chance to build a more functional thumb that they can use for the rest of their lives.

Why Are Thumbs Important?

What’s in a thumb? Even as babies, our thumbs are important for more than just thumb sucking. They help us grip things effectively. As we grow, they make it much easier to improve our fine motor skills—like coloring, buttoning a shirt, holding a fork and combing our hair.

Later, the thumb also comes in handy for throwing baseballs, riding bikes, writing and typing. When you lack a thumb or finger that moves opposite to the rest of the fingers (this is why it’s called an opposable thumb), you have a less strong, controlled grip on tools, utensils and anything else you may want to hold or move.

Building a Thumb

There are two main ways we can do hand surgery to make a thumb for someone without one.

Pollicization: This is where a surgeon takes another finger (usually the pointer finger) and turns it into a thumb.

• It involves surgically moving the finger to where a thumb should be. Then it is rotated it so it functions like a thumb.
• We leave the finger’s existing arteries, veins and nerves in place, and use tendons and nerves to give the new thumb as natural and normal a function as possible.
• This is most often done when a child is totally missing a thumb since birth, or when it is lost due to trauma.

Thumb Reconstruction: This is where a surgeon strengthens and rebuilds an existing thumb to make it more useful.

• Many times, kids born with underdeveloped thumbs just need extra support, strength, flexibility, or changes to the skin webbing to make their existing thumb more useful. In these cases, a surgeon can create a better web (bringing in more skin from the hand, or creating a deeper web with a new cut).
• Surgeons can also rebuild tendons and ligaments to make the thumb more functional.
• Sometimes, a small thumb that is missing a necessary thumb joint will be removed and replaced with another finger.

Form and Function for New Thumbs

In most cases, kids who have surgery to construct a thumb don’t end up with totally normal function or strength in the thumb. However, by focusing as closely on the function under the skin as we do on how it looks from the outside, hand surgeons work hard to make new thumbs as useful and normal-looking as possible.

Building thumbs for babies born without one is something I love doing. It is a rewarding part of my job as a hand surgeon to help give kids with thumb hypoplasia, aplasia or hand trauma a new chance at near-normal hand function and appearance.

If you are a family who may be considering an operation to treat one of these conditions, click here to learn more about the Hand and Upper Extremity Program at Nationwide Children’s Hospital.