Doctor: Remove the thumb and perform index finger pollicization.
Mother: No, I want to keep my child's thumb. Even if the function isn't perfect, it can at least assist the right hand. I don't want her to lose a finger.
This is a little girl who is almost 4 years old. Her left thumb looks like a small soft lump, without independent bone or joint structure. It simply swings along with the movement of the hand.
Because of this unusual little hand, even when she reached kindergarten age, her family hesitated to send her to school. The child is very sensitive and has already started asking her mother, "Why is my hand different from other children's?"
Before coming to me, the mother had consulted several doctors. Some recommended index finger pollicization, while others suggested harvesting iliac bone to reconstruct and preserve the thumb. Neither option was acceptable to her. She kept searching for a more balanced solution-until she learned online about hemi-metacarpal transplantation reconstruction, a technique that uses bone taken from the child's own hand to rebuild the thumb. That is when she brought her daughter to see me.
After a comprehensive evaluation, I systematically compared three options for the mother:
First, index finger pollicization. Remove the thumb and reconstruct it using the index finger. The outcome is relatively predictable, but the child would be left with only four fingers.
Second, iliac bone graft reconstruction. This preserves the five-finger appearance, but adds additional trauma and pain at the pelvic donor site.
Third, hemi-metacarpal transplantation reconstruction. This preserves the five-finger appearance while concentrating the surgical trauma in the hand, avoiding additional injury to other parts of the body.
The child's thumb was in a borderline condition.
If it had been slightly smaller, I would have advised against preservation because the reconstruction effect would be minimal. However, her current condition provided a possibility for saving the thumb.
The hemi-metacarpal reconstruction will be performed in two stages:
Stage one: Reconstruct the first metacarpal to provide a stable bony framework for the thumb.
Stage two: Reconstruct thumb opposition to restore grasping function.
After surgery, the thumb will certainly be somewhat shorter than normal, and its range of motion will be limited. However, with systematic functional training, she can reasonably expect to pick up toys, pinch small beans, and assist the other hand in many daily tasks in the future.