Double Opposing Stiletto Flaps for Pediatric Finger Flexion Contractures.

Area of Science:

• Orthopedic Surgery
• Pediatric Hand Surgery
• Reconstructive Surgery

Background:

• Pediatric finger flexion contractures involve contracted volar tissue, forming pterygia or webs that restrict joint movement.
• These contractures can result from various etiologies, including burn scars and congenital conditions like camptodactyly.
• Effective surgical techniques are crucial for restoring function and improving the quality of life for affected children.

Purpose of the Study:

• To introduce and evaluate the double opposing stiletto (DOS) flap technique for managing pediatric finger flexion contractures.
• To assess the efficacy of the DOS flap in releasing transverse contracted volar tissue and covering defects.
• To determine the functional and aesthetic outcomes of the DOS flap technique in pediatric patients.

Main Methods:

• Retrospective review of pediatric patients (n=8) treated with the DOS flap technique between June 2022 and September 2025.
• The study included contractures from burn scars (10 fingers) and camptodactyly (2 fingers) affecting interphalangeal joints.
• Postoperative management involved casting/splinting followed by hand therapy; outcomes were assessed via clinical images and joint angle measurements.

Main Results:

• All eight pediatric patients achieved the ability to lay their hands flat post-surgery, indicating significant functional improvement.
• The DOS flap technique demonstrated viability in all 12 treated digits, with sustained improvements in finger joint angles.
• Average finger joint angles improved from 50° preoperatively to 15.5° immediately postoperatively and 9.5° at follow-up.

Conclusions:

• The double opposing stiletto (DOS) flap technique is a viable and effective addition to the surgical armamentarium for pediatric finger flexion contractures.
• The technique successfully releases contracted tissue and utilizes available pterygium tissue for reconstruction, with primary closure of donor sites.
• The DOS flap offers sustained functional improvement in finger joint mobility for pediatric patients.