gms | German Medical Science

14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

Article

Send article

Correction of Thumb Duplication: A Systematic Review of Surgical Techniques

Meeting Abstract

Search Medline for

  • presenting/speaker Robert Miller - Royal London Hospital, London, United Kingdom
  • Dariush Nikkhah - Queen Victoria Hospital, East Grindstead, United Kingdom

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-1904

doi: 10.3205/19ifssh0022, urn:nbn:de:0183-19ifssh00220

Published: February 6, 2020

© 2020 Miller et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Objectives/Interrogation: Surgical intervention for thumb duplication can be divided into three categories: simple excision of the accessory thumb, excision of the accessory thumb with reconstruction from available 'spare parts' and combining the two thumbs into one, as described by Bilhaut. This prospectively PROSPERO registered systematic review evaluates the overall, aesthetic and functional outcomes for the latter two options, aiming to facilitate evidence-based decision making when addressing thumb duplication and direct future research.

Methods: The review was performed in accordance with the Cochrane Handbook of Systematic reviews and PRISMA statement. Embase, PubMed, Medline and Cochrane databases were systematically searched. Studies offering comparisons of techniques were included. Risk of bias was assessed using the ROBINS-I tool. The quality of the evidence was assessed using the GRADE.

Results and Conclusions: Ten retrospective observational studies were included. Data did not consistently allow analysis by procedure type. Four studies reported similar overall outcomes between techniques, whilst two specifically reported poor overall outcomes for the Bilhaut procedure. Two studies reported comparatively worse aesthetic outcomes for the Bilhaut procedure with four studies reporting comparatively improved functional outcomes for this procedure. Overall, interpretation of outcomes was challenging with no patient reported outcome measures used. The quality of the evidence was universally 'very low' due to all studies being at risk of methodological bias.

Based on the available evidence, surgical techniques for thumb duplication correction appear comparable regarding overall outcome. There is limited evidence suggesting reconstruction with spare parts offers superior aesthetic outcomes at the expense of stability. However, the quality of available evidence is poor with few comparative studies, much heterogeneity between methods regarding outcome reporting and significant challenges regarding bias.

Further research is needed in the form of well conducted prospective comparative studies comparing surgical techniques. These should use appropriate patient reported outcome measures to facilitate evidence-based, patient orientated, decision making regarding the surgical management of thumb duplication.