Creating Thumbs Using Index Pollicization

Thumb aplasia is a rare congenital defect — occurring in one out of every 100,000 births — in which a child is missing one or both thumbs. Because the condition is so uncommon, few surgeons get an opportunity to develop the advanced skills required to treat it effectively. In his career as an orthopaedic surgeon specializing in congenital hand abnormalities, Bobby Chhabra, MD, chair of the UVA Department of Orthopaedic Surgery, has treated more than a dozen of these young patients.

“I have been seeing kids with congenital hand conditions since 2002,” says Chhabra, co-creator of UVA Hand Center. “It is one of my passions and I’ve really made it one of the focuses of my practice because it’s very gratifying for me. ”

One of the more challenging patients with thumb aplasia Chhabra has treated, Connor Woodle was referred to UVA Hand Center at just two weeks of age. He was missing not one, but both of his thumbs.

“The absence of two thumbs is unusual,” says Chhabra. “The question I had immediately was, ‘What can we do to ensure Connor leads a normal, healthy, high-functioning life?’”

Because these kids often have other problems as a result of other genetic abnormalities, which may impact the heart, lungs, kidneys, spine or legs, Chhabra turned to a team of UVA specialists, including geneticists, developmental pediatricians, therapists and others, who helped ensure Connor received a comprehensive evaluation.

“You really need a team of people,” says Chhabra. “I just take care of the hands, wrists and elbows, so it’s comforting for me to know that these patients have access to leading specialists at UVA that can give them the best possible all-around care.”

Opting to Treat
Over the course of a year, Connor adapted to his missing thumbs by using two fingers as pincers to grasp objects. What he lacked, however, was the dexterity and strength only thumbs can provide.

“The hard part is determining whether these kids need surgery, and if so, what is the best option,” says Chhabra. “The goal is to improve function, and not just the cosmetic appearance. If a procedure decreases functionality, then you’re doing a disservice to the child.”

In discussing Connor’s options for treatment with his parents, Jason and Joan Woodle of Charlottesville, Chhabra shared that there was one procedure called index pollicization that he believed could give Connor almost complete and normal use of his hands. “Pollicization is one of the most fascinating operations I’ve ever seen and one of the main reasons I went into hand surgery,” says Chhabra. “It isn’t a lifesaving procedure like heart surgery, but if you have a good outcome it could change a child’s life,” says Chhabra.