Functional and aesthetic outcomes after index pollicization using two different techniques in children with thumb hypoplasia - A comparative study.

Background: As several skin incision patterns have been described when performing index pollicization, it is currently difficult to know whether one incision is superior to another.

Hypothesis: Functional and aesthetic outcomes of two techniques of pollicization that differ in the incision pattern (Buck-Gramcko and Malek's technique) were analyzed.

Patients and methods: Of 81 patients operated on between 1987 and 2021, 43 self-questionnaires were completed on 48 pollicized hands and 24 were reviewed for the study. Eighteen and 30 pollicizations were performed according to Buck Gramcko's and Malek's techniques, respectively.

Results: Following a functional analysis evaluation, no significant differences were observed between the two groups in terms of the appearance of the first commissure, active abduction of the neo-thumb, grip assessment, scar appearance and visibility, and neo-thumb girth. However, passive abduction of the thumb was better in the group operated on using Buck-Gramcko's technique at the last follow-up. Regardless of the technique used, patients were generally satisfied with the overall function, aesthetics, and daily use of the neo-thumb, as demonstrated by self-completed questionnaires.

Conclusion: This investigation demonstrated the superiority of Buck-Gramcko's technique in terms of passive abduction of the thumb. There was no impact on the function or aesthetics of the neo-thumb, and the results were comparable across the different techniques. The main prognostic factor requiring additional procedures involving opposition muscle transfer is the association with a radial club hand.

Level of evidence: Level III-Retrospective comparative study.