Surveying Cultural Preferences for Toe-to-Thumb Transfer Versus Pollicization

For thumb reconstruction after a traumatic hand injury, a lack of objective data on outcomes following index pollicization versus toe-to-thumb transfer has left patients and providers with few unbiased guideposts. To provide cultural context that may aid decision-making, Jacques H. Hacquebord, MD, co-director of the Center for Amputation Reconstruction, and colleagues collaborated with international researchers to examine differences in preferences and outcome expectations among hand surgeons and the general public in six Eastern and Western countries.

Despite previous suggestions that preferences may depend upon location, their analysis revealed that the majority of surgeons involved in the study favored toe-to-thumb transfer over pollicization. In contrast, the general public didn’t strongly favor one procedure over the other, regardless of location.

Surgeons held more optimistic expectations than the public on both procedures, underscoring the necessity of research to evaluate and more conclusively determine which reconstruction procedure optimizes patient outcomes. As it stands today, the researchers suggest discussing the pros and cons of each procedure, and ensuring good alignment in outcome expectations prior to surgery, to increase patient satisfaction and decrease anxiety and subsequent conflict.

“Assumptions around culture should be made very carefully. Our analysis shows that patients around the world are much more similar in their preferences than previously thought,” Dr. Hacquebord says.