Pollicization of the index finger is a surgical technique proposed to treat severe hypoplasia and aplasia of the thumb [[1], [2], [3], [4], [5], [6]]. Most surgeons performing pollicization follow the technical principles described by Buck-Gramcko after the Thalidomide tragedy, which caused an unprecedented number of congenital anomalies. Over a hundred pollicizations have been performed, leading to considerable improvements in the technique and enabling the author to establish three essential rules: 1) the pollicized index finger must retain its own neurovascular pedicle, 2) the neo-thumb requires a skeletal readjustment, including rotation and length, to allow for opposition and stability; and 3) motor skills of the thumb must be ensured through muscle transfers [2].

Incisions and skin flaps are essential for achieving functional and aesthetic results. They must provide access to the pedicles and coverage for osteoarticular, muscular, and neurovascular structures. Additionally, they must allow for opening of the new first web space, avoiding any transverse suture lines. Consequently, the formation of a commissural cord can restrict thumb mobility and grasp prehension, affecting the functional outcome [7]. Although several skin incision patterns have been described, it is difficult to determine whether one pattern is superior to another [8].

This study aimed to analyze mid- to long-term functional and aesthetic outcomes by comparing two techniques with different incision patterns: Buck-Gramcko’s and Malek’s techniques [2,9].