Treatment of children with skin and soft tissue defects of distal phalanges of the fingers

Abstract

Introduction. This article discusses the relevance of performing organ-preserving operations for traumatic skin and soft tissue defects in children. The author analyzes the traditional types of skin grafting procedures and their application in children. From the authors' point of view, the most acceptable skin grafting method is a displaced island flap on a neurovascular pedicle with direct blood flow.

Materials and methods. The operating technique of lifting a displaced island flap on a neurovascular pedicle with direct blood flow is shown. The features of its implementation, the number of children, and their distribution by groups are shown. From 2016 to 2019, 15 children with traumatic defects of the distal phalanges of the fingers were operated on in the microsurgical Department of the Khabarovsk KKB No. 2 using a displaced neurovascular island flap on the leg with “direct” blood flow. The children ranged in age from four to 14 years. The number of children and the frequency of damage to the right and left hands was approximately the same.

Results. Positive results of using this technique in the Department of Microsurgery of KKB No. 2 are presented. In all cases, it was possible to close the existing defects with the primary closure of the donor defect simultaneously; Sensitivity was preserved in all operated children, and movements in the finger joints were almost complete.

Discussion. This flap method has undeniable advantages, although it is quite time-consuming and requires microsurgical skills, techniques, and appropriate equipment. The proposed skin grafting results are encouraging and satisfying for both doctors and children with parents.

Conclusions. The authors recommend this skin grafting method for traumatic defects of the distal phalanges of the fingers in children.

Keywords

injury / distal phalanx / skin defect / skin plastic surgery / hand function / children

References

[1] Баиндурашвили А.Г., Соловьева К.С., Залетина А.В., и др. Детский травматизм и оказание специализированной помощи детям Санкт-Петербурга // Ортопедия, травматология и восстановительная хирургия детского возраста. — 2013. — Т. 1. — № 1. — С. 4–9. [Baindurashvili AG, Solovieva KS, Zaletina AV, et al. Children’’s injuries and special care service for children of St. Petersburg. Pediatric Traumatology, Orthopedics and Reconstructive Surgery. 2013;1(1):4–9. (In Russ.)] https://doi.org/10.17816/PTORS114-9

[2] Vadivelu R, Dias JJ, Burke FD, Stanton J. Hand injuries in children: a prospective study. J Pediatr Orthop. 2006;26(1):29–35. https://doi.org/10.1097/01.bpo.0000189970.37037.59

[3] Jeon B-J, Lee J-I, Roh SY, et al. Analysis of 344 Hand Injuries in a Pediatric Population. Arch Plast Surg. 2016;43(1):71–76. https://doi.org/10.5999/aps.2016.43.1.71

[4] Liu WH, Lok J, Lau MS, Hung YW, et al. Mechanism and epidemiology of paediatric finger injuries at Prince of Wales Hospital in Hong Kong. Hong Kong Med J. 2015;21(3):237–242. https://doi.org/10.12809/hkmj144344

[5] Weir Y. Fingertip injuries in children: a review of the literature. Emerg. Nurse. 2018;26(3):17–20. https://doi.org/10.7748/en.2018.e1795

[6] Gellman H, Gellman HJ. Fingertip-nail bed injuries in children: current concepts and controversies of treatment. Craniofac Surg. 2009;20(4):1033–1035. https://doi.org/10.1097/SCS.0b013e3181abb1b5

[7] Гордиенко И.И., Цап Н.А. Открытые травмы ногтевых фаланг пальцев кисти у детей // Вестник Уральского государственного медицинского университета. — 2018. — № 2. — С. 32–34. [Gordienko II, Tsap NA. Fragnastic fingers of the brush in children. Vestnik Ural’skogo gosudarstvennogo meditsinskogo universiteta. 2018;(2):32–34. (In Russ.)] https://doi.org/10.31550/1727-2378-2019-160-5-34-37

[8] Voth M, Lustenberger T, Frank J, Marzi I. Finger- und Handverletzungen bei Kindern [Pediatric finger and hand injuries: An epidemiological study]. Chirurg. 2017;88(10):871–878. (In German) https://doi.org/10.1007/s00104-017-0499-8

[9] Stokes JR, Png ME, Jain A, Greig AVH, et al. Should the nail plate be replaced or discarded after nail bed repair in children? Nail bed INJury Analysis (NINJA) randomised controlled trial: a health economic and statistical analysis plan. Trials. 2020;21(1):833. https://doi.org/10.1186/s13063-020-04724-1

[10] Venkatesh A, Khajuria A, Greig A. Management of Pediatric Distal Fingertip Injuries: A Systematic Literature Review. Plast Reconstr Surg. 2020;8(1):e2595. https://doi.org/10.1097/GOX.0000000000002595

[11] Valencia J, Leyva F, Gomez-Bajo GJ. Pediatric hand trauma. Clin Orthop Relat. Res. 2005;(432):77–86. https://doi.org/10.1097/01.blo.0000155376.88317.b7.

[12] Arata J, Ishikawa K, Soeda H. The palmar pocket method: An adjunct to the management of zone I and II fingertip amputations. J Hand Surg (Am). 2001;26(5):945–950. https://doi.org/10.1053/jhsu.2001.27763

[13] Krishnan KG. Sensory recovery after reconstruction of defects of long fingertips using the pedicled V flap. Br J Plast Surg. 2001;54(6):523–527. https://doi.org/10.1054/bjps.2001.3647

[14] Omokawa S, Takaoka T, Shigematsu K. Reverse-flow island flap from the thenar area of the hand. J Reconstr Microsurg. 2002;18(8):659–664. https://doi.org/10.1055/s-2002-36496

[15] Netscher DT, Meade RA. Reconstruction of fingertip amputations with full-thickness perionychial grafts from the retained part and local flaps. Plast Reconstr Surg. 1999;104(6):1705–1712. https://doi.org/10.1097/00006534-199911000-00014

[16] Dautel G, Corcella D, Merle M. The role of Mepitel silicone net dressings in the management of fingertip injuries in children. J Hand Surg (Br). 1999;24(6): 727–730. https://doi.org/10.1054/JHSB.1999.0270

[17] Mennen U, Wiese A. Fingertip injuries management with semi-occlusive dressing. J Hand Surg (Br). 1993;18(4):416–422. https://doi.org/10.1016/0266-7681(93)90139-7

[18] Fox JW, Golden GT, Rodeheaver G. Nonoperative management of fingertip pulp amputation by occlusive dressings. Am J Surg. 1977;133(2):255–256. https://doi.org/10.1016/0002-9610(77)90094-0

[19] Wahba G, Cheung K. Pediatric hand injuries: Practical approach for primary care physicians. Can Fam Physician. 2018;64(11):803–810.

[20] Biddulph SL. The neuro vascular flap in finger tip injuris. The Hand. 1979;11(1):59–64. https://doi.org/10.1016/S0072-968X(79)80011-X

[21] Venkataswami R, Subramanian N. Oblique triangular flap: a new method of repair for oblique amputations of the fingertip and thumb. Plast Reconstr Surg. 1980;66:296–300. https://doi.org/10.1097/00006534-198008000-00026

[22] Evans DM, Martin DL. Step-advancement island flap for fingertip reconstruction. Br J Plast Surg. 1988;41:105–111. https://doi.org/10.1016/0007-1226(88)90035-5

[23] Adani R, Busa R, Castagnetti C, Bathia A, Caroli A. Homodigital neurovascular island flaps with “direct flow” vascularization. Annals of Plastic Surgery. 1997(1):36–40. https://doi.org/10.1097/00000637-199701000-00007

[24] Foucher G, Smith D, Pempinello C. Homodigital neurovascular island flaps for digital pulp loss. J Hand Surg (Br). 1989;(14):204–208. https://doi.org/10.1016/0266-7681(89)90127-7

[25] Wang B, Chen L, Lu L, Liu Z, et al. The homodigital neurovascular antegrade island flap for fingertip reconstruction in children. Acta Orthop Belg. 2011;77(5):598–602

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Berezutskii S.N., Pinigin A.G.