The Power of Pollicization: Creating a Thumb for Michael
The Power of Pollicization: Creating a Thumb for Michael
Reviewed by Apurva S. Shah, MD, MBA
Reviewed on
On the day Michael was born, his mother discovered something about her son was different.
Shortly after delivery, a question from a doctor about whether new mom Barbara had seen Michael’s hand quickly became a deeply charged moment.
“I just saw [Michael’s hands] were tiny. I didn't see a difference.”
This moment would soon become an important one, a key source of empowerment and ultimately a story of success, thanks to Barbara’s commitment and the work of Apurva S. Shah, MD, MBA, and the rest of the pediatric orthopedic hand and arm team at Children’s Hospital of Philadelphia (CHOP).
“If the research showed [the best doctor for thumb hypoplasia] was in Europe, I would fly there.”
The tiny thumb Michael was born with on his right hand was not functional.
“There was no bone connecting,” Barbara said. “It was just a floating thumb.”
Thumb hypoplasia is the medical term for missing or underdeveloped thumbs. Doctors near their home in Florida suggested pollicization could be a possible treatment. Pollicization is a complex and life-changing procedure that involves removal of the non-functional thumb and construction of a new useable thumb by moving the index finger to the thumb position.
Overwhelmed, Barbara knew she needed to take a moment to breathe.
And research.
That research brought her to a community of parents and patients with thumb hypoplasia. Much more than just a Facebook support group, it became a place for Barbara to ask questions, read the stories of other parents and maybe understand her own story a bit better.
“I met an airplane pilot, 30 years old, and he had pollicization on both hands. So, he has four fingers on both hands, and he passed all his tests to fly a plane.”
The pilot, seeing others with uncertainty about pollicization, decided to share about himself in the group. It was the first time Barbara had encountered an adult who had the surgery and considered it the best decision they could have made.
The pilot wasn’t alone.
There were others in the group as well, including folks whose parents had decided their child should not get the procedure done. To Barbara, there seemed to be consistent themes of pain, and reports of a digit that was mostly unusable.
“A lot of people that didn't remove it say they regret it, and the thumb gets in the way,” Barbara said.
“Dr. Shah really took the time to explain, and he would not let us leave until we understood everything.”
As Barbara continued to research, Dr. Shah and the orthopedic hand and arm team at CHOP appeared repeatedly in comments and articles recommending the best doctors for treating thumb hypoplasia. The team at CHOP had extensive experience with both thumb reconstruction and pollicization for children with thumb hypoplasia.
And when the consultation – done in-person with Dr. Shah’s team in Philadelphia – turned out to be as thorough and caring as it could have been, Barbara felt herself hope again. Dr. Shah reviewed the advantages and disadvantages of several surgical options for children with thumb hypoplasia, including reconstruction of the existing thumb versus pollicization.
In Michael’s case, pollicization was still the suggested treatment, but this time, the family felt prepared to make the call, setting a date to return to Philadelphia for the procedure.
It’s natural, of course, to wonder what your child’s future will look like, especially when facing a medical diagnosis.
Looking back though, Barbara is stunned that she ever considered not having pollicization done.
“[Michael] uses his right hand for everything. He's in school writing and his left hand has five fingers, but he uses the right hand with four fingers.”
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“We spent the night there in the hospital [after surgery] and it was great. They kept coming and checking on him all the time.”
Thumb reconstruction surgery at CHOP
At 18 months old, the ideal age for pollicization, Michael and Barbara travelled back to Philadelphia for the procedure. Dr. Shah asked Barbara and Michael to remain in the area for at least 48 hours following surgery to ensure Michael was healing as expected.
“But right away [Michael] was already playing and climbing couches," Barbara said.
Despite Michael’s quick recovery, the team kept a close eye on their patient – even when Dr. Shah had to attend a conference the day after Michael’s surgery.
“[Dr. Shah] was like, ‘I don't like to have surgeries and not be available.’ But it was so smooth.”
Barbara and Michael spent the next few days in an apartment in Philadelphia, checking in regularly with Dr. Shah’s team — something which continued even after Barbara and Michael then returned home.
It was only a matter of weeks before the family was back at CHOP, this time so that Dr. Shah could remove the cast and reveal Michael's new hand.
“‘Think about his thumb being functional.’”
Michael, who is naturally math-inclined and already counts over 100, only started to notice the difference himself once he began to count using his fingers.
“I was putting him to bed one time, he was two years old and he's like, ‘Mommy, I have four fingers on this hand, but I have five fingers on this hand.’”
But while it was once Barbara’s greatest fear, it simply never seemed to phase Michael.
Today, Barbara is happy to find that few kids and, in fact, almost no adults notice Michael’s difference.
People usually just assume Michael was born this way.
Even Barbara forgets about the difference at times, a testament to the treatment’s effectiveness – and Michael’s resilience.
“He's so confident and he's so okay with it.”
“He uses his hands just like all the other kids his age.”
Now 4 years old, Michael has a great sense of humor, lots of friends and a busy activity schedule.
And Barbara is even more certain that she made the correct choice for her son.
"He's already doing Legos, building stuff and he uses both hands equally. So, I have no concerns really for his future.”
Barbara remains in close contact with Dr. Shah and the team at CHOP, sending pictures and keeping them updated on Michael’s accomplishments.
And she also remains an active and supportive member of the Facebook group, all too happy to share about her family’s experience at CHOP.
“I'm so thankful that we found [CHOP]. And I'm glad that I took the time to breathe and do the research.”
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