Role of five-fingered hand in type IIIB thumb hypoplasia- an Asia-Pacific perspective

The management of type IIIB thumb hypoplasia in the Asia-Pacific region is predominantly shaped by cultural views, with numerous countries favouring a five-fingered hand. The article discusses the evolution of treatment for type IIIB thumb hypoplasia with thumb preservation and reconstruction and the dilemma of excision and pollicization. Recent research has revealed the limitations of pollicization including joint instability and diminished grip strength. Moreover, several parents, particularly in the Asia-Pacific region, exhibit hesitancy towards thumb excision owing to cultural, psychological, or religious considerations, favouring the retention of a five-fingered hand. This has prompted continuous investigation into alternate techniques that preserve thumb stability while facilitating a functional five-fingered hand. Recent strategies have demonstrated encouraging outcomes comparable to conventional pollicization. In several instances, staged treatments are necessary to provide a five-fingered hand, although the reconstructed thumb may exhibit functional and developmental limits. This alternative procedure has demonstrated favourable functional and aesthetic benefits, with minimal donor morbidity, comparable to that of pollicization.