BACKGROUND: The recommended treatment for Blauth types IIIB and IV congenital thumb hypoplasia is index pollicization and amputation of the functionless, hypoplastic thumb. Instead of completely discarding the functionless part, the authors retain a portion of the soft tissue as an adipofascial vascular island flap. This flap is inset at the base of the new thumb to simulate a thenar eminence and to improve the appearance of these hands. METHODS: This flap was used to augment the thenar base in 14 hands in 14 children. Follow-up ranged from 1 to 26 years. RESULTS: All pollicizations were successful and there were no major complications. All of the adipofascial flaps improved the appearance of the thenar eminence and held up their shape in the long term. CONCLUSIONS: Use of an adipofascial island flap is recommended for thenar eminence augmentation in index pollicization of types IIIB and IV thumb hypoplasia. This tissue improves the appearance of the hand, is easy to harvest, and adds no morbidity.
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