Principalization of pollicization of the index finger in congenital absence of the thumb.

After reviewing our experience with pollicization in congenital cases of thumb hypoplasia or aplasia, we found that classic techniques have several weak points concerning function and appearance. Abduction is frequently inadequate, and adduction is quite weak. Esthetically the thumb has a slender aspect, the web fold is absent, and the commissure looks more like a cleft. We tried to prioritize the issues to propose some technical modifications for improvement of function and appearance.