The enhancement of function takes priority in the management of children with congenital hand anomalies. The authors conducted a systematic review of studies of pollicization and centralization surgery to examine functional outcome. The search strategy included MEDLINE, CINAHL, and reference lists from secondary resources. The selection criteria included all literature pertaining to the functional outcome of children having either pollicization or centralization surgery. The studies were analyzed according to the levels of evidence for primary research. Ten studies were reviewed; one study was evaluated at level 3 and the remaining were level 4. Rigorous research of functional outcome is needed to validate surgical interventions. Enhancing the quality of functional outcome studies in this population requires improvements in research methodology, sampling, and measurement of function.