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Incidence and treatment of complications, suboptimal outcomes, and functional deficiencies after pollicization
Charles A Goldfarb1, Eric Monroe, Jennifer Steffen
1Shriners Hospital for Children and the Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA. goldfarbc@wustl.edu
Purpose:
To evaluate the incidence and treatment of complications, suboptimal outcomes, and functional deficiencies after pollicization, and the need for additional surgical procedures.
Methods:
A total of 73 index finger pollicizations performed by a single surgeon were identified. We retrospectively evaluated all available patient records for perioperative complications, suboptimal outcomes, and functional deficiencies of the pollicized digit.
Results:
There were 8 complications in the perioperative period (including 3 cases of venous congestion, 4 cases of marginal necrosis, and 1 infection), requiring 12 surgical procedures; 1 pollicized digit was removed owing to nonviability. There were 8 suboptimal outcomes, including 7 cases of scar contracture and 1 with redundant skin, requiring 3 surgical procedures. Additional procedures related to functional deficiencies were performed in 26 total patients, 19 for poor opposition and 15 for limited extension.
Conclusions:
Most perioperative complications and suboptimal outcomes after pollicization are minor when an experienced surgeon is involved. Venous congestion, although uncommon, is a major viability risk and should be treated aggressively. In addition, a substantial number of pollicized digits have functional deficiencies related to anatomical limitations that can be addressed with muscle and tendon transfers.
Type Of Study/Level Of Evidence:
Therapeutic IV.
Insights
Pollicization surgery for congenital hand differences has a low incidence of minor complications when performed by experienced surgeons. Functional deficiencies are common but treatable with additional procedures.
Area of Science:
- Hand surgery
- Congenital hand differences
- Microsurgery
Background:
- Pollicization is a reconstructive procedure for thumb hypoplasia.
- Evaluating outcomes is crucial for optimizing surgical techniques.
Purpose of the Study:
- To assess complications, functional deficits, and outcomes after pollicization.
- To determine the need for secondary surgical interventions.
Main Methods:
- Retrospective review of 73 index finger pollicizations by a single surgeon.
- Analysis of perioperative complications, suboptimal outcomes, and functional deficiencies.
Main Results:
- 8 perioperative complications (venous congestion, necrosis, infection) required 12 procedures; 1 digit was removed.
- 8 suboptimal outcomes (scar contracture, redundant skin) needed 3 procedures.
- 26 patients had functional deficiencies (poor opposition, limited extension) addressed surgically.
Conclusions:
- Experienced surgeons achieve mostly minor complications.
- Aggressive treatment of venous congestion is vital for viability.
- Muscle and tendon transfers can address functional deficits effectively.
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