Factors Affecting Appearance after Thumb Polydactyly Reconstruction - A Caregiver's Perspective in an Asian Population.

Background: Current research on thumb polydactyly reconstruction focusses primarily on clinical evaluations. Details on aesthetic outcomes are relatively lacking. This study aims to address this gap by: (1) investigating the effectiveness of surgical treatment in achieving symmetrical thumb size, length and girth; (2) assessing aesthetic outcomes from a caregiver's perspective and (3) identifying key factors that influence aesthetic outcomes to inform strategies to improve surgical reconstruction. Methods: Patients who underwent thumb polydactyly reconstruction were recalled for assessment. Objective measurements of both the reconstructed and unaffected thumbs were taken. Surgical scars were evaluated by measuring their length and using the Vancouver Scar Scale (VSS). To assess the appearance of the reconstructed thumbs, we used the Visual Analogue Scale (VAS) through surveys completed by the primary caregiver of each patient. Caregivers also provided reasons for any unsatisfactory appearance outcomes and we correlated these with objective factors. Results: This study included 26 paediatric patients with 29 reconstructed thumbs. The mean VAS score for overall thumb appearance was 7.8 ± 2.2. While surgical treatment achieved symmetry in most anthropometric measures, reconstructed thumbs had smaller nail plates and greater joint angulation. Caregiver assessment of thumb width was closely related to the objective interphalangeal joint (IPJ) girth measurements, and perceived excessive angulation was related to the IPJ angle. Symmetry was not associated with nail fold width or scar location. However, perceived scar prominence was linked to VSS score and scar location. Conclusions: Thumb polydactyly reconstruction achieves symmetry in size, length and girth, but nail plate size and joint angulation remain significant challenges. Despite this, caregivers are generally satisfied with the overall appearance. Attention should be focussed on improving thumb IPJ girth, IPJ angulation and scar location to enhance overall aesthetic outcomes. Level of Evidence: Level IV (Therapeutic).