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Pediatric thenar flaps: a modified design, case series and review of the literature
Jason S Barr1, Michael W Chu1, Vishal Thanik1
1Institute of Reconstructive Plastic Surgery, Department of Plastic and Reconstructive Surgery, New York University Medical Center, New York, NY, USA.
Insights
The thenar flap is a safe and effective surgical option for reconstructing pediatric fingertip injuries with pulp loss. This study shows good functional and sensory outcomes in young patients, with no complications.
Area of Science:
- Pediatric Surgery
- Hand Reconstruction
- Trauma Surgery
Background:
- Fingertip injuries are common in children, often requiring soft-tissue reconstruction for pulp loss.
- The thenar flap is a recognized technique, but its application in pediatric cases is less documented.
Purpose of the Study:
- To evaluate the safety and efficacy of the thenar flap procedure for pediatric fingertip amputations.
- To assess functional and sensory outcomes following thenar flap reconstruction in children.
Main Methods:
- Retrospective review of pediatric patients undergoing thenar flap reconstruction from 2000 to 2010.
- Analysis of patient demographics, defect size, surgical timing, and functional outcomes including range of motion and sensibility.
Main Results:
- Sixteen pediatric patients (average age 10.8 years) underwent thenar flap reconstruction for fingertip pulp loss.
- Excellent functional recovery was observed, with average total active range of motion near normal limits for all joints.
- Objective sensibility testing showed good results, with an average static two-point discrimination of 7mm, and no reported complications.
Conclusions:
- The thenar flap is a safe and effective reconstructive option for pediatric fingertip injuries.
- The procedure yields favorable functional and sensory outcomes in young patients.
- This technique addresses the need for soft-tissue restoration in pediatric hand trauma.
Background:
Fingertip injuries are extremely common in children, and severe trauma with pulp loss requires soft-tissue reconstruction to restore length, bulk, and sensibility. The thenar flap is a well-described technique but there are few reports of its use in pediatric patients.
Methods:
Pediatric thenar flap reconstructions were retrospectively identified from October 2000 to October 2010 at a single institution.
Results:
Sixteen pediatric patients (eleven male, five female) underwent thenar flap procedures. The average age was 10.8years (1.1-17.8years). The average defect size was 1.5cm×1.5cm (1cm(2)-2cm(2)). Division and inset occurred on average 16days later (12-24days). Average follow-up was 6.8months (4.1-9.6months). The average total active range of motion (TAM) in flexion was 248° (235°-260°) [normal maximum: 260°]. All patients had 85° metacarpophalangeal joint (MCPJ) range of motion (ROM) [normal maximum: 85°]. The average proximal interphalangeal joint (PIPJ) ROM was 103° (95°-110°) [normal maximum: 110°] in flexion, and an average 60° distal interphalangeal (DIPJ) ROM (55°-65°) [normal maximum: 65°] in flexion. Objective sensibility in the flap was ascertained as an average static two-point discrimination of 7mm (6mm-10mm) in 10 compliant patients and was grossly intact in all other patients. There were no complications.
Conclusions:
The thenar flap is a safe and effective option for pediatric fingertip amputation injuries requiring soft-tissue reconstruction.
