Abstract
1. Absence of a thumb, whether congenital or due to injury, is a severe disability. Reconstructive surgery has much to offer.
2. Pollicisation is the most satisfactory method, being the only means of providing a thumb with normal tactile sensibility. The importance of this has often been overlooked and has been emphasised by Moberg (1958). Pollicisation offers also the best functional and aesthetic results. When applicable, the neurovascular pedicle technique of Littler is the one of choice. It is indicated in group 2 cases associated with a partly amputated finger, when this is swung on to the thumb stump, and for patients in groups 3 and 4 when the normal index finger is used. If this method is not feasible a staged pollicisation may be used instead.
3. The Gillies method of thumb lengthening has a more limited application, but it is valuable in selected cases.
4. Reconstruction by tubed pedicle and bone graft is seldom indicated and is best reserved for reconstruction in the mutilated hand when local elements are deficient.
5. Replacing a thumb by a toe should be reserved for exceptional cases.
6. Autografting the amputated thumb is feasible, and should be considered when the amputated digit has been preserved.
