Double Opposing Stiletto Flaps for Pediatric Finger Flexion Contractures

Pediatric finger flexion contractures can have wide transverse contracted volar tissue resulting in a pterygium or web of tissue extending across the affected joints. Here, we establish the double opposing stiletto (DOS) flap technique for releasing the skin of the flexion joint contracture transversely and then recruiting flap tissue from both the radial and ulnar aspects of the pterygium to cover the volar defect and with primary closure of flap donor sites.

The study includes pediatric patients with flexion joint contractures resulting from burn scar or camptodactyly etiologies treated with the DOS flap technique between June 2022 and September 2025 in a Pediatric Hand Surgery practice. Patient information and clinical images were collected through a retrospective chart review.

A total of eight pediatric patients were included. The average age was 8 years old (range, 5-14 years old). A total of 12 finger DOS flaps were reviewed (8 proximal interphalangeal, 3 distal interphalangeal, and one thumb interphalangeal joints). Pediatric flexion joint contractures were from burn etiology (10 fingers) and camptodactyly (2 fingers). After surgery, patients were cast or splinted, followed by hand therapy for nighttime splinting. Follow-up time after surgery was 7 months (range, 2-12 months). Prior to surgery, patients were unable to lay their hand flat, and after the surgery, all could lay their hand flat. All digits and flaps were viable, with all demonstrating sustained improvement in finger joint angles (ImageJ software) with photographed outcomes. Finger joint average angles were preoperative angle 50° (range, 18° to 83°), immediate postoperative angle 15.5° (range, 0° to 46°), and follow-up angle 9.5° (range, 0° to 43°).

The DOS flap technique can be added to the armamentarium for pediatric finger flexion contractures with available pterygium tissue.

Therapeutic IV.