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Use of forearm flaps for the severely contracted first web space in children with congenital malformations
J Upton1, R J Havlik, C J Coombs
1Children's Hospital, Boston, MA, USA.
Insights
Radial forearm flaps effectively treated congenital anomalies in pediatric patients, offering excellent aesthetic and functional outcomes for first web-space contractures. This surgical technique provides a reliable solution for significant tissue defects.
Area of Science:
- Plastic Surgery
- Pediatric Surgery
- Hand Surgery
Background:
- Congenital anomalies of the hand, particularly first web-space contractures, present significant functional and aesthetic challenges.
- Previous surgical interventions may complicate treatment options for these complex conditions.
Purpose of the Study:
- To evaluate the efficacy of forearm flaps in reconstructing defects following the release of severe first web-space contractures in pediatric patients.
- To assess the functional and aesthetic outcomes of using radial forearm axial pattern flaps and dorsal interosseous system flaps.
Main Methods:
- Retrospective analysis of 18 forearm flap procedures in 12 pediatric patients with congenital anomalies.
- Preference for radial forearm axial pattern flaps in 10 children; dorsal interosseous system flaps used in 2 patients.
- Ten flaps were performed in children under 2 years of age.
Main Results:
- Excellent aesthetic and functional results were achieved in the majority of patients.
- One patient experienced superficial skin loss, indicating a low complication rate.
- The flaps provided successful coverage for large tissue deficiencies post-release.
Conclusions:
- Local vascular island flaps, specifically forearm flaps, are a highly effective reconstructive option for congenital first web-space contractures in children.
- These flaps offer superior aesthetic and functional restoration, making them a valuable alternative for complex hand reconstruction.
Abstract:
Eighteen forearm flaps were used in 12 patients with congenital anomalies following release of severe first web-space contractures. Radial forearm axial pattern flaps were preferred in 10 children, and the dorsal interosseous system was used in 2 patients with incomplete palmar arches and those who had previous surgery. Ten of the flaps were transferred in children younger than 2 years of age. The results were excellent both esthetically and functionally. Superficial skin loss occurred in one patient. These local vascular island flaps are an excellent alternative for coverage in situations where a large tissue deficiency exists after an adequate release.