CPT® Code 26550

Official Description

Pollicization of a digit

Common Language Description

Pollicization of a digit is a surgical procedure that involves the transfer of one of the fingers, most commonly the index finger, to the anatomical position of the thumb. This procedure is typically indicated for patients who have experienced a traumatic amputation of the thumb, or for those who have congenital conditions resulting in the absence or underdevelopment (hypoplasia) of the thumb. The surgical technique begins with an incision made over the metacarpal bone, which is the long bone in the hand that supports the thumb and fingers. During the procedure, careful dissection of the soft tissues is performed, with particular attention to preserving the neurovascular structures that supply the hand. The midportion and base of the index finger's metacarpal bone are excised, while the metacarpal head is preserved. This preservation is crucial as the metacarpophalangeal joint of the index finger will serve as the new carpometacarpal joint for the reconstructed thumb, and the metacarpal head will take on the role of the trapezium bone, which is the bone that articulates with the thumb. Following the excision, the index finger is rotated into the position of the thumb. To enhance the functionality of the new thumb, the lateral slips of the dorsal aponeurosis are mobilized, and the two interossei muscles of the index finger are detached and fixed in a shortened position to the lateral slips on both sides of the newly positioned thumb. This rearrangement of the interossei muscles is designed to improve the thumb's function, allowing for full or nearly full opposition and abduction, which are essential movements for grasping and pinching. Additionally, this technique helps to create a thenar eminence, which is the fleshy prominence at the base of the thumb, contributing to a more cosmetically acceptable appearance of the new thumb. Finally, a dorsoradial skin flap is created and rotated to cover the gap that exists between the newly formed thumb and the adjacent middle finger, completing the reconstruction.

1. Indications

The procedure of pollicization is indicated for specific conditions that affect the thumb's functionality and appearance. These include:

Traumatic Amputation - This procedure is performed on patients who have lost their thumb due to an accident or injury, necessitating reconstruction to restore hand function.
Congenital Absence of the Thumb - Pollicization is indicated for individuals born without a thumb, providing them with a functional digit that can perform essential tasks.
Hypoplasia of the Thumb - In cases where the thumb is underdeveloped, pollicization can create a more functional and aesthetically pleasing thumb by utilizing the index finger.

2. Procedure

The pollicization procedure involves several critical steps to ensure the successful transfer of the index finger to the thumb position. Each step is meticulously executed to achieve optimal results.

Step 1: Incision and Dissection - The procedure begins with an incision made over the metacarpal bone of the index finger. The surgeon carefully dissects the soft tissues surrounding the metacarpal, ensuring that neurovascular structures are preserved to maintain blood supply and sensation.
Step 2: Excision of Metacarpal Bone - The midportion and base of the index finger's metacarpal bone are excised, while the metacarpal head is preserved. This step is crucial as it allows the metacarpophalangeal joint of the index finger to function as the new carpometacarpal joint for the reconstructed thumb.
Step 3: Rotation of the Index Finger - After the excision, the index finger is rotated into the anatomical position of the thumb. This rotation is essential for the new thumb to align properly with the other digits of the hand.
Step 4: Mobilization of Dorsal Aponeurosis - The lateral slips of the dorsal aponeurosis are mobilized to facilitate the attachment of the interossei muscles, which play a vital role in thumb movement.
Step 5: Detachment and Fixation of Interossei Muscles - The two interossei muscles of the index finger are detached and fixed in a shortened position to the lateral slips on both sides of the newly positioned thumb. This rearrangement enhances the thumb's functionality, allowing for improved opposition and abduction.
Step 6: Creation of Dorsoradial Skin Flap - A dorsoradial skin flap is created and rotated to cover the gap between the newly formed thumb and the middle finger. This step is important for ensuring a smooth and aesthetically pleasing transition between the digits.

3. Post-Procedure

After the pollicization procedure, patients can expect a recovery period that may involve immobilization of the hand to allow for proper healing. Post-operative care typically includes monitoring for any signs of infection, managing pain, and ensuring that the surgical site remains clean. Physical therapy may be recommended to help regain strength and mobility in the newly formed thumb, as well as to improve overall hand function. The expected outcome is a functional thumb that allows for improved grasping and pinching abilities, along with a more cosmetically acceptable appearance.

Short Descr	POLLICIZATION DIGIT
Medium Descr	POLLICIZATION DIGIT
Long Descr	Pollicization of a digit
Status Code	Active Code
Global Days	090 - Major Surgery
PC/TC Indicator (26, TC)	0 - Physician Service Code
Multiple Procedures (51)	2 - Standard payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50)	1 - 150% payment adjustment for bilateral procedures applies.
Physician Supervisions	09 - Concept does not apply.
Assistant Surgeon (80, 82)	2 - Payment restriction for assistants at surgery does not apply to this procedure...
Co-Surgeons (62)	0 - Co-surgeons not permitted for this procedure.
Team Surgery (66)	0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family	99 - Concept Does Not Apply
APC Status Indicator	Hospital Part B services paid through a comprehensive APC
ASC Payment Indicator	Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight.
Type of Service (TOS)	2 - Surgery
Berenson-Eggers TOS (BETOS)	P3D - Major procedure, orthopedic - other
MUE	1
CCS Clinical Classification	160 - Other therapeutic procedures on muscles and tendons