Reconstruction of the congenitally deficient thumb.

Hand function in patients with congenitally deficient thumbs can usually be improved by operative procedures. The specific operation depends on the type of hypoplasia present. It is important for the surgeon to determine whether the thumb can be retained and made more functional by various reconstructive procedures, or whether it should be ablated in favor of a single-stage index finger pollicization. This decision is particularly difficult in patients with type III hypoplastic thumbs, in whom both the osseous and musculotendinous structures may be significantly affected. It is nearly impossible to perform pollicization as a salvage procedure after attempts to reconstruct a retained thumb have failed. The principles presented may assist the surgeon in this decision-making process. Pollicization itself is an exacting procedure requiring attention to numerous details. The surgeon and parents must realize that additional operative procedures may be required to enhance the function of the pollicized digit.