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Nine children with congenital aplasia or hypoplasia of the thumb were treated by pollicisation of the index finger. Functional assessment was performed on average five years after surgery. It demonstrated normal sensation and a power grip, pinch grip and adductor grip of the thumb of 63%, 56% and 63% respectively of the unoperated hand. Efficient use of the hand increased after surgery and continued to improve for some years. The results indicate that pollicisation benefits hand function and should be performed early.