"Our child's issue is with his thumb, but the local doctor said it has to be removed."
"As parents, I can understand the doctor's perspective, but if there's even a small chance to save it, we want to try. We don't want him to feel self-conscious about it in the future."
This father's determination to save his child's floating thumb left a deep impression on me.
Initial Consultation
Born with Thumb and Heart Issues
This 8-year-old boy was diagnosed with Type IV thumb hypoplasia, commonly known as a floating thumb. Since birth, his family had been tirelessly seeking medical help-not just for his thumb but also due to a congenital heart condition. After receiving treatment and stabilizing his heart condition, the father finally brought him in to address the thumb issue.
The father had consulted multiple doctors, and the proposed surgical plans always involved either amputating the underdeveloped thumb and converting the index finger into a thumb (pollicization) or reconstructing the thumb's metacarpal using a bone graft from the child's foot. However, he struggled to accept these solutions.
"Why remove my child's thumb when it's still there?"
"Why injure his healthy foot just to fix his hand?"
Still searching for answers, he came to me for a consultation.
Initial Consultation
How can the floating thumb be saved without amputation or taking a bone graft from the foot?
Although the child's floating thumb is quite severely affected, the thumb itself is of a sufficient size, making it worth preserving. Instead of amputating or using a bone graft from the foot, we can perform a part of metacarpal bone graft from the second metacarpal of the same hand to reconstruct the first metacarpal. This way, the surgical area is limited to the hand itself.
This would be the first stage of surgery. The second stage would focus on thumb's movement, using tendon transfers to provide functional motion to the thumb.
How long should the gap be between the two surgeries?
A second surgery can typically be performed about 3.5 months after the first.
Should the surgery be done in spring or summer?
Since it is a two-stage procedure, the first surgery can be done in spring and the second in summer. This timing would also be more convenient for the child and parents, as summer vacation allows for better post-surgery care. However, the choice of season does not significantly impact surgical outcomes. The key is ensuring proper post-operative care.
Will the child need rehabilitation therapy after surgery?
Yes, but it doesn't require hospital-based therapy-rehabilitation can be done at home.
Parents should: Encourage the child to perform opposition movements of palm during the day. Create environments that promote thumb use, such as playing with two-handed toys, twisting screws, and picking up small objects like beans. These activities help stimulate and strengthen the thumb.
X-ray
How soon after surgery can the child return to school?
Since it's the left hand, it won't affect his ability to hold a pencil and write. However, he will need to be careful at school to avoid injuring the recovering thumb.
Every child is the hope of their family. As parents, we only want them to grow up healthy and confident. With surgery, his thumb will be saved, its function will improve, and his parents will finally have peace of mind.