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Satisfaction with hand appearance in children with index pollicization for thumb hypoplasia
B Sandvall1, S Atkins1, D McCombe2
1Plastics and Maxillofacial Surgery Department, Royal Children's Hospital, Melbourne, Australia.
Insights
Children undergoing index pollicization for thumb hypoplasia report high satisfaction with hand appearance. However, patient self-assessments may be more subjective than objective outcomes, especially in older children.
Area of Science:
- Hand surgery
- Pediatric orthopedics
- Plastic surgery
Background:
- Index pollicization is a surgical procedure to reconstruct a thumb.
- While functional improvement is primary, aesthetic outcomes are also crucial for patient well-being.
- Thumb hypoplasia presents challenges in hand function and appearance.
Purpose of the Study:
- To evaluate patient and observer satisfaction with hand appearance after index pollicization for thumb hypoplasia.
- To compare patient, parent, surgeon, and non-surgeon assessments of aesthetic outcomes.
- To identify factors influencing satisfaction with hand appearance post-surgery.
Main Methods:
- A cohort of 18 patients who underwent index pollicization for thumb hypoplasia was assessed.
- Patients and parents rated hand appearance using a 10-point visual analogue scale (VAS).
- Independent surgeons and non-surgeon observers also rated hand appearance from standardized photographs.
Main Results:
- Median patient-reported and parent-reported satisfaction scores were 9 (IQR: 7-10).
- Older children (≥12 years) showed a trend towards lower satisfaction with appearance.
- Patient self-assessment correlated negatively with non-surgeon ratings, indicating subjective influence.
Conclusions:
- Index pollicization generally yields high patient and parent satisfaction with hand appearance.
- Subjective factors significantly influence a patient's perception of their hand's aesthetic outcome.
- Further research may explore nuanced patient-specific aesthetic goals in pediatric hand reconstruction.
Abstract:
Although the primary aim of pollicization is to augment function, aesthetic improvement is an important secondary aim. Satisfaction with hand appearance in children with index pollicization for thumb hypoplasia was evaluated in 18 patients at an average of 7.5 years after surgery. Patients and their parents rated the appearance of their operated hand using a 10-point visual analogue scale (VAS). Four independent surgeons and 16 non-surgeon observers also rated the hands after reviewing standardized photographs of each child. The median patient-reported and parent-reported scores were 9 for both groups (IQR: 7-10) with a trend for children 12 years and older, to report lower satisfaction with appearance. The non-surgeon group assessments varied more for a given hand than the surgeons' assessments, though when scores were averaged within these groups for each hand, there was a high degree of correlation between the two groups. Surprisingly, the patient's own assessment showed a trend towards negative correlation when compared with the average rating of the non-surgeon assessors, suggesting that patients' own assessment of their hand's appearance is more affected by subjective factors than the objective physical outcome.
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