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Simultaneous Bilateral Pollicization is Effective and Efficient
George Edwards III, MD; Nina Lightdale-Miric, MD; Tamara Alexandrov, MD; Jamie Berggren, OTR; Stephanie Iantorno, BA; Milan Stevanovic, MD
Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA

Introduction: In patients with bilateral deformities of the hand indicating index finger pollicization on both sides, the surgeon must decide whether to perform the procedures simultaneously during one operation or separately in a staged fashion. No evidence-based guidelines exist in the literature regarding the advantages and disadvantages of simultaneous vs. staged pollicization. The purpose of our study was to compare functional outcomes of bilateral pollicization to those of unilateral pollicization and to evaluate relevant concerns including patient safety, family satisfaction, and cost-efficiency.

Methods and Materials: A retrospective chart review was performed to identify all patients who underwent index finger pollicization on one or both hands by a single surgeon at one institution between 1995 and 2012. Forty seven patients were identified, and of these patients, 24 agreed to return to the clinic for evaluation: 7 patients who underwent simultaneous bilateral pollicization (14 hands), 2 patients who underwent staged bilateral pollicization (4 hands), and 8 patients who underwent unilateral pollicization (8 hands). Functional assessments were carried out by a single occupational therapist and included the Humphry-Jewell assay, Child Health Assessment Questionnaire, pinch strength, grip strength, visual analog scales, and patient and parent satisfaction scores. Surgical data were obtained from charts, and cost data were obtained from hospital records. The results of simultaneous bilateral and unilateral pollicization were compared. Significance was determined by studentís T-test.

Results: Average time between surgery and functional assessment was 4 years (ranging from 10 months to 9 years). There were no significant differences in functional outcomes between the simultaneous and unilateral groups in any domain (P=0.472). Average surgical time was 352 minutes and 175 minutes for the bilateral and unilateral groups, respectively. Average tourniquet time for each hand was 107 minutes and 111 minutes for the bilateral and unilateral groups, respectively (P= 0.752). There were no surgical complications in either group. Simultaneous bilateral pollicization was significantly less costly for the hospital than staged pollicization.

Conclusions: Simultaneous bilateral pollicization had equivalent functional outcomes when compared to unilateral pollicization. From a safety perspective, simultaneous surgery offers the advantage of a single anesthetic exposure. Additionally, simultaneous bilateral pollicization is more cost-efficient than staged pollicization and involves decreased total recovery time with a single rehabilitative period. For these reasons, we feel simultaneous bilateral pollicization is a safe and successful procedure and should be strongly considered as an option for patients with bilateral indications.

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