Purpose
Data objectively comparing outcomes following pollicization versus toe-to-thumb transfer
for reconstruction after traumatic thumb amputation in adults remains sparse. Given
that this decision is reliant on personal preference, it is important to understand
the subjective nature of these preferences, particularly in the context of culture.
The purpose of this study was to compare Eastern and Western societal and hand surgeon
preferences for pollicization versus toe-to-thumb transfer for traumatic thumb reconstruction.
Methods
Investigators from 6 international locations recruited local hand surgeons and members
of the general population. Austria, Germany, the United States, and Spain were grouped
as “Western” nations. China and India separately represented “Eastern” nations. Participants
completed a questionnaire evaluating their personal preferences for pollicization
and toe-to-thumb transfer. The questions posed to the general population and hand
surgeons were identical. Demographic data were also collected.
Results
When comparing the Western nations, China, and India, there was no difference in personal
preferences within the general population for pollicization versus toe-to-thumb transfer.
In contrast, most Indian hand surgeons favored toe-to-thumb transfer and most Western
surgeons were uncertain about which procedure they would favor. Surgeons had more
optimistic expectations regarding postoperative hand function, new thumb sensation,
and hand appearance following pollicization than the general population. Similarly,
for toe-to-thumb transfer, a greater proportion of surgeons predicted good-to-excellent
function, sensation, and appearance.
Conclusions
There was no clear, observed “East” versus “West” difference in the general population’s
personal preferences for pollicization versus toe-to-thumb transfer among study participants.
The members of the general population and hand surgeons had different outcome expectations.
Clinical Relevance
Understanding how culture influences patient and hand surgeon preferences for pollicization
versus toe-to-thumb transfer may help guide future decision-making for traumatic thumb
reconstruction.
Key words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Hand SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Anatomy, physiology, and functional restoration of the thumb.Ann Plast Surg. 1996; 36: 180-191
- Biomechanics of the hand.Hand Clin. 2013; 29: 483-492
- Treatment of nonreplantable total thumb amputation at the CMC level using index finger pollicization.Hand (N Y). 2022; 17: 1154-1162
- Surgical reconstruction of congenital thumb hypoplasia.Indian J Plast Surg. 2011; 44: 253-265
- Toe-to-hand transfer: evolving indications and relevant outcomes.J Hand Surg Am. 2013; 38: 1431-1434
- Pollicization of the index finger: method and results in aplasia and hypoplasia of the thumb.J Bone Joint Surg Am. 1971; 53: 1605-1617
- Toe to hand transfer in children. Part 1. Technical aspects.J Hand Surg Br. 1996; 21: 723-734
- Current reconstruction options for traumatic thumb loss.J Hand Surg Am. 2016; 41: 1159-1169
- Change in hand function and dexterity with age after index pollicization for congenital thumb hypoplasia.Plast Reconstr Surg. 2018; 141: 691-700
- Pediatric toe-to-hand transfer: an assessment of outcomes from a single unit.J Hand Surg Eur Vol. 2016; 41: 281-294
- Comparative study of outcomes between pollicization and microsurgical second toe-metatarsal bone transfer for congenital radial deficiency with hypoplastic thumb.J Reconstr Microsurg. 2013; 29: 587-592
- Pollicization: the concept, technical details, and outcome.Clin Orthrop Surg. 2012; 4: 18-35
- Methods for congenital thumb hypoplasia reconstruction. A review of the outcomes for ten years of surgical treatment.Medicina (Kaunas). 2019; 55: 610
- The second toe-to-hand transfer for full-length thumb reconstruction in congenital thumb’s grade IIIb to V hypoplasia: MTPJ arthrodesis instead of tendon rebalansing.Tech Hand Up Extrem Surg. 2020; 24: 13-19
- Reconstruction of a congenital hypoplastic thumb with use of a free vascularized metatarsophalangeal joint.J Bone Joint Surg Am. 1998; 80: 1469-1476
- Thumb hypoplasia.J Hand Surg Am. 2013; 38: 1435-1444
- Traumatic finger amputation treatment preference among hand surgeons in the United States and Japan.Plast Reconstr Surg. 2016; 137: 1193-1202
- Shared decision making in surgery: a meta-analysis of existing literature.Patient. 2020; 13: 667-681
- Cross-cultural variation in preference for replantation or revision amputation: societal and surgeon views.Injury. 2016; 47: 818-823
- A comparative study of attitudes regarding digit replantation in the US and Japan.J Hand Surg Am. 2015; 40 (1646-1656.e16563)
- Surgical experts: born or made?.Int J Surg. 2013; 11773778
- Justifying our decisions about surgical technique: evidence from coaching conversations.Surgery. 2018; 164: 561-565
- Putting patients first: ambulatory surgery facilitates patient-centered care.Curr Opin Anaesthesiol. 2021; 34: 667-671
Article info
Publication history
Published online: January 31, 2023
Accepted:
December 8,
2022
Received:
March 31,
2022
Publication stage
In Press Corrected ProofFootnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2023 by the American Society for Surgery of the Hand. All rights reserved.
