Objective To provide clinical anatomical evidence to optimize index finger pollicization for congenital thumb hypoplasia in children. Methods Twenty hands from healthy children aged 5-8 years were dissected. Macroscopic and microscopic analyses were performed to study the morphology and innervation of first palmar and dorsal interosseous muscles, focusing on anatomical features associated with common surgical deficiencies. The resection and reattachment points of interosseous muscle and extrinsic muscle tendons were observed. Simulated pollicization procedures were conducted to determine optimal techniques for muscle reattachment and nerve preservation. Results The first palmar interosseous muscle was small, approximately half size of dorsal interosseous muscle, and primarily inserted into the ulnar side of dorsal capsule of proximal interphalangeal joint. The radial bundle of first dorsal interosseous muscle originated from the ulnar side of the first metacarpal, and the ulnar bundle from the radial side of the second metacarpal, converging to insert into the radial side of the second metacarpophalangeal joint capsule and dorsal aponeurosis. The deep branches of ulnar nerve entered the muscles from palmar side, nearly perpendicular to the direction of the incision on second metacarpal periosteum. Optimal reattachment points for interosseous muscles were located adjacent to the flexor aspect of the reconstructed thumb's interphalangeal joint capsule, consistent with their original insertions. The proximal segments of the flexor and extensor tendons were shortened by approximately 2 cm and sutured end-to-end to the corresponding tendons of the reconstructed thumb, preserving the original line of pull. Conclusions Anatomical reconstruction using the first palmar and dorsal interosseous muscles as intrinsic dynamic muscles, fixed near the flexor aspect of the reconstructed thumb's interphalangeal joint capsule, is recommended. Securing the periosteum containing interosseous muscles to the newly created metacarpal and performing proximal tendon shortening with end-to-end repair align force transmission and tendon tension with native anatomy, promoting ideal functional outcomes.
Key words
Congenital thumb developmental deformity /
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Index finger pollicization /
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Function of oppenens pollicis /
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Clinical anatomy
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