Outcome of index finger pollicisation for the congenital absent or severely hypoplastic thumb

Pollicisation of the index finger for absence or severe hypoplasia of the thumb has been reported as a good procedure to recreate a new "thumb" with good cosmesis and acceptable function. The purpose of this study is to evaluate the outcome of our series. Seventeen patients with 24 involved hands agreed to come back for evaluation. The mean age at operation was 12 months. In 8 hands there was also a radial club hand. Buck Gramcko's technique was used with slight modifications. The mean follow-up time was 53 months (range, 6-142 months). The outcome was determined in a variety of ways: objective assessment of function and cosmesis (measurement of thumb length, girth and nail size), and subjective evaluation of function and aspect done with a patient/parent questionnaire and a visual analogue score. The mean functional score was excellent for one hand, good for eleven, fair for five and poor for five. The mean length was 96%, the width was 93%, the nail width was 85% as compared with the contralateral thumb. There was no significantly different outcome in the syndrome-related thumbs versus the isolated cases, nor in unilateral versus bilateral cases. A significantly worse outcome was seen for function and subjective evaluation in the radial clubhand associated thumbs and for the functional score for the more severe Blauth group.