Buck-Gramcko pollicization of index finger. A and B, Palmar and dorsal skin incisions. C, Rotation of metacarpal head into flexion to prevent postoperative hyperextension. D, Index finger rotated about 160 degrees along long axis to place finger pulp into position of apposition. E, Final position of skeleton in about 40 degrees of palmar abduction with metacarpal head secured to metacarpal base or carpus. F, Reattachment of tendons to provide control of new thumb. First palmar interosseous (PI) functions as adductor pollicis (AP); first dorsal interosseous (DI) as abductor pollicis brevis (APB); extensor digitorum communis (EDC) as abductor pollicis longus (APL); and extensor indicis proprius (EIP) as extensor pollicis longus (EPL). G and H, Appearance after wound closure. SEE TECHNIQUE 80.30.