"World understandings for thumb hypoplasia"- the German view.

In Germany and other European countries, pollicization is still indicated for thumb hypoplasia Manske type IIIB, IV and V. The one-stage procedure is well established and only the details have been refined over the years. In experienced hands, it is a safe operation with few complications. European surgeons focus on overall function combined with the best possible appearance when treating congenital malformations. With pollicization, we can create a thumb that looks and works like a thumb, that can spread, pinch and grasp objects. The function of a Manske type IV with pollicization is better than that of a thumb reconstruction. The European centres for congenital malformations prefer pollicization of the index finger for Manske type IIIB due to good function, growth and having experienced disappointing results after reconstruction with an avascular toe phalanx transfer. The benefit of the complex reconstruction technique with a vascularized hemimetatarsal has not yet been demonstrated. For a fair comparison, we need more data on adult patients with a long follow-up and using the same evaluation scores to determine the correlation between function, appearance, and health-related quality of life in both techniques.