https://www.gosh.nhs.uk/conditions-and-treatments/procedures-and-treatments/pollicisation-for-hypoplastic-or-absent-thumb-what-to-expect-after-hand-surgery/
Pollicisation for hypoplastic or absent thumb– what to expect after hand surgery
This webpage provides information about what to expect after pollicisation. Pollicisation is a surgical procedure where the index finger is reconstructed into a thumb.
What should I expect after the operation?
Your child’s hand will remain heavily bandaged after the operation. The doctors may leave the tip of their thumb visible, to make sure that blood is flowing to their thumb. Try to keep the bandage as clean and dry as possible. Your child will have a wound review on Magpie with the clinical nurse specialists three weeks after the operation.
The hand will take around three to six weeks to heal. Once the hand has healed, we will see your child in Occupational Therapy for hand therapy.
Does my child need a hand splint?
Your child may need a thermoplastic splint to protect their hand. They might only need this whilst their hand heals, but some people will also need to wear this longer term at night. If your child needs a hand splint, we’ll give you more information on this.
What type of hand therapy will they need to do?
There are several types of hand therapy your child will need to do after surgery:
Your child will have a scar from the surgery- regular massage can help the scar to stay soft, hydrated and mobile. Massage can also help to desensitise the scar and help your child get used to the feel of their new hand.
- Start massage only once the wound is fully healed and the stitches have fallen out.
- Rub any cream into the entire length of the scar.
- Use circular or zigzag motions around the whole area.
- Try and massage for 3-5 minutes.
The joints of the new thumb need to be moved gently after surgery. We recommend:
- Do wide circular movements at the base of the thumb, 3-5 times in each direction. This will help the thumb to move away from the palm and rotate to face the fingers (opposition).
- Flex (bend) and extend (straighten) the middle and top joints of your child’s thumb 3-5 times.
We will show you how to do these movements.
Please note: if your child’s index finger did not have full motion before the operation, it is unlikely their new thumb will have full motion after the operation.
It is important to get the muscles and tendons working in the hand again to help them have more movement and opposition. We recommend that your child:
- Tries to touch their new thumb to all their fingertips, one at a time.
- Tries holding small, light objects between their thumb and each of their fingers.
- Progresses towards touching their thumb to the base of their little finger.
You can also do isolated movements to focus on one joint at a time. We will show you how to do this.
How often should my child do hand therapy?
We recommend doing hand therapy at least 3-5 times a day. Try to link hand therapy in with other daily routines like meals or baths. Set reminders and make progress or sticker charts to help motivate your child.
When can my child start using their hand again?
Depending on healing, your child can start to use their hand again around three to six weeks after their surgery. This should be for light daily activities.
As your child has a new grasp, they will need to practice using their hand to allow the brain to ‘rewire’. Ways of encouraging them to use their new thumb include:
- Place light, medium sized objects into their hand to encourage them to grasp the object between their new thumb and their other fingers.
- Let them feel and get used to the object, and practise using their new grasp.
- Suitable objects include a glue stick, toy car or built-up cutlery.
- When your child is ready, encourage them to pick objects up themselves by actively opening their new thumb away from their hand.
- Encourage them to release the object too.
- Repeat this motion over and over to help the motor learning within the brain.
- They may continue to use scissor grip between other fingers, which is normal. Continue to prompt them to use their new thumb.
Once your child is using their new thumb to grasp medium objects, you can work on improving their fine motor skills to hold smaller objects such as play coins, raisins or pencils. As before, you may need to place the smaller object into their hand and help them to hold it and work towards them using this pinch actively. Offer toys and games that require two hands to encourage them to use their new thumb.
Your child’s new thumb will be weak compared to their other fingers. Once they’re using their new grasp and pinch, they should then work on improving the strength and overall function of their hand. They can build hand and arm strength through age-appropriate activities like play dough, squeezing sponges, colouring, origami, climbing, scootering or cycling.
Other things to consider
Your child should avoid high impact activities until 3-6 months after their surgery, like trampolining, racket sports and gymnastics.
Your child will need lots of opportunities and practice to use their new grip. Praise and rewards may help motivate them.
You may find it helpful to restrain their other hand in a fun, non-threatening way to encourage the use of their operated hand. Speak to us for ideas about this.
Who can I contact if I have questions or concerns?
For further information and support, please call us:
Occupational Therapists (OT) in Plastic Surgery: 020 7405 9200 ext: 0223