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Thenar flap for severe finger tip injuries in children
F Fitoussi1, A Ghorbani, P Jehanno
1Department of Orthopaedic Surgery, Robert Debre Hospital, Paris, France. franck.fitoussi@wanadoo.fr
Insights
A distal-based thenar flap effectively treated severe fingertip amputations in children, restoring function and form without complications. This surgical technique offers a viable solution for complex pediatric hand injuries.
Area of Science:
- Plastic Surgery
- Pediatric Hand Surgery
- Reconstructive Surgery
Background:
- Severe fingertip amputations in children often involve significant pulp loss.
- Replantation may not be feasible for all such injuries.
- Alternative reconstructive methods are needed to restore fingertip function and aesthetics.
Purpose of the Study:
- To evaluate the efficacy of the distal-based thenar flap for treating severe pediatric fingertip amputations.
- To assess functional and aesthetic outcomes following this reconstructive procedure.
Main Methods:
- A retrospective review of twelve children (18 months–11 years) with severe fingertip amputations.
- Treatment involved reconstruction using a distal-based thenar flap.
- Flap pedicles were divided after 18–25 days.
Main Results:
- No flap necrosis was observed.
- Excellent functional recovery with an average two-point discrimination of 5mm.
- Satisfactory aesthetic results with rounded fingertip contour and asymptomatic scars.
Conclusions:
- The distal-based thenar flap is a reliable and effective technique for severe pediatric fingertip injuries.
- It provides sufficient soft tissue for reconstruction when local flaps are inadequate or replantation is not an option.
- The procedure yields good functional and cosmetic outcomes in young patients.
Abstract:
Twelve children aged between 18 months and 11 years old who had sustained a severe fingertip amputation with total or subtotal pulp loss were treated with a distal-based thenar flap. The injuries were palmar oblique amputations or avulsion injuries involving the pulp and the nail bed. The pedicles of the thenar flaps were divided after 18 to 25 days and none suffered any necrosis. At the final follow-up, no interphalangeal joint contractures were found, the average two point discrimination was 5mm, the thenar scar was asymptomatic and the subcutaneous tissue of the thenar flap was providing sufficient bulk to produce a rounded contour, like a normal fingertip. The thenar flap is a useful technique for use with severe fingertip injuries when local flaps cannot provide enough soft tissue and replantation is not possible.
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