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A 5-Year Interval Evaluation of Function after Pollicization for Congenital Thumb Aplasia Using Multiple Outcome Measures

Aliu, Oluseyi M.D.; Netscher, David T. M.D.; Staines, Kimberly G. O.T.R., C.H.T.; Thornby, John Ph.D.; Armenta, Arturo M.D.

Plastic and Reconstructive Surgery: July 2008 - Volume 122 - Issue 1 - p 198-205
doi: 10.1097/PRS.0b013e318177427d
Hand/Peripheral Nerve: Original Articles

Background: The authors aimed to determine the functional improvement rate over a 5-year interval among patients who had undergone index finger pollicization for isolated thumb absence compared with age-matched controls. They also investigated suggestions in previous reports that tissue remodeling in reconstructed thumbs causes improvements in function outpacing normal development.

Methods: Five patients (seven hands) evaluated 5 years earlier with grip, lateral pinch, and tripod pinch strength tests; the pegboard Functional Dexterity Test; the Jebsen Hand Function Test; standard radiographs; and parent questionnaires on appearance, social interactions, and functionality were reevaluated. Percentage changes were compared with expected changes from published norms.

Results: Regarding grip strength, patients showed a 148 percent increase compared with 102 percent in controls. Regarding lateral and tripod pinch, patients had 99 and 125 percent increases compared with 78 and 69 percent in controls, respectively; the differences were not significant between groups. Functional dexterity outcomes showed the same trend. Controls improved in the five administered subtests of the Jebsen tests. In three Jebsen subtests, patients accomplished the tasks in 40 to 45 percent less time than 5 years previously. Parent perspectives were comparable to 5 years previously. Previously, 60 percent of responses were in the best category and 4 percent were in the worst category. Those percentages were 58 and 6 percent, respectively, in this study.

Conclusions: Although this was a small study group, it seems that children who have undergone index finger pollicization have changes in function comparable to normal development. Parents still have positive perspectives of the reconstructed thumb. There is no evidence that tissue remodeling causes improvement outpacing normal development.

Houston, Texas

From the Division of Plastic Surgery and Department of Orthopedic Surgery, Baylor College of Medicine; Hand Surgery Service, Texas Children's Hospital; Plastic Surgery Section, Veterans Affairs Medical Center; Physiotherapy Sports Medicine; and Department of Internal Medicine, Baylor College of Medicine, Michael E. DeBakey Veterans Affairs Medical Center.

Received for publication June 25, 2007; accepted October 25, 2007.

David T. Netscher, M.D.; Plastic Surgery Section; Veterans Affairs Medical Center; 6624 Fannin Street, Suite 2730; Houston, Texas 77030;

Disclosure: None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this article.

©2008American Society of Plastic Surgeons