The Gillies’ Thumb Lengthening Operation

Abstract

The standard Gillies’ thumb-stall operation is a most successful method of lengthening a thumb which has been lost in the region of the metacarpophalangeal joint and where all four fingers are intact. Pollicisation is not considered justifiable in such a case. The method achieves a result in a one-stage procedure and provides a strong, useful thumb although of limited length. Should a deeper thumb/index web be required, this may readily be achieved by a Z-plasty, although this has rarely been found necessary. Sensation on the tactile surface is good. We consider this is due to the fact that the median nerve supply over the palmar aspect of the thumb is left intact. Normal sensation has been demonstrated over the volar surface of the thumb at an early stage following operation. The cosmetic appearance would, generally speaking, not be acceptable in a female patient and an alternative method has usually been used viz., tubed pedicle, bone graft and island flap. Free transfer of the second toe has given good cosmetic results and has been described by Gilbert and Tubiana (1979) and le Quang (1979). A working man, however, readily accepts the cosmetic result particularly when taken in conjunction with a relatively short rehabilitation period.