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

Research finds no major differences among Eastern and Western populations and surgeons.

In a survey of the general public (n = 202), researchers asked whether people thought they would prefer a toe-to-thumb transfer or pollicization for a thumb reconstruction after a traumatic injury, and no strong preference between the procedures was indicated. For respondents from China, 35.6 percent strongly or somewhat favored pollicization, 46.7 percent strongly or somewhat favored toe-to-thumb transfer, and 17.8 percent were unsure. For respondents from India, 34.7 percent strongly or somewhat favored pollicization, 57.2 percent strongly or somewhat favored toe-to-thumb transfer, and 8.2 percent were unsure. For respondents from Western countries, 38.4 percent strongly or somewhat favored pollicization, 50.5 percent strongly or somewhat favored toe-to-thumb transfer, and 11.1 percent were unsure.

In a survey of the general public (n = 202) and surgeons (n = 106), surgeons underestimated the public’s perceived importance of having a five-digit hand. When asked how important it was to have a 5-digit versus 5-digit hand, 81.5 percent of respondents in the general population said it was important or very important, 6.0 percent said it was unimportant or very unimportant, and 12.5 percent had no opinion. Of the surgeons questioned, 58.7 percent said it was important or very important, 37.5 percent said it was unimportant or very unimportant, and 3.8 percent had no opinion.

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.

“Assumptions around culture should be made very carefully … patients around the world are much more similar in their preferences than previously thought.”
Jacques H. Hacquebord, MD

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.

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Jacques H. Hacquebord, MD

Orthopedics

Jacques H. Hacquebord, MD, is an associate professor in the Department of Orthopedic Surgery and the Hansjörg Wyss Department of Plastic Surgery and co-director of the Center for Amputation Reconstruction. He specializes in treating patients with severe hand injuries through reconstructive surgery and microsurgery.

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

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Jacques H. Hacquebord, MD

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

Featured Experts

Jacques H. Hacquebord, MD

Your Partner in Every Patient’s Care

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