A complex soft tissue reconstruction of distal phalanges in children

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Abstract

BACKGROUND: Injuries of distal phalanges are the most common type of hand trauma in children. The problem of coverage of soft tissue defects of distal phalanges remains. Many methods of coverage of distal phalanges defects have been developed. There is no generally accepted approach or an algorithm in treatment of adults and children with such type of trauma.

AIM: This study aimed to reveal the most universal method of coverage of distal phalanges defects in children using various reconstruction methods that are used at the Department of Reconstructive Microsurgery of Filatov State Children Hospital.

MATERIALS AND METHODS: From 2019 to 2020, 70 children with defects of distal phalanges were treated. The coverage of defects was performed by using a flap (n = 23), cross-finger flap (n = 5), V-Y advancement flap (n = 28), reverse-flow homodigital island flap (n = 11), and full-thickness skin graft (n = 3). Results of the defect coverage were evaluated by objective (difference between the lengths of the operated and contralateral phalanges, two-point discrimination test, presence/absence of stiffness in the distal interphalangeal joint) and subjective (definition of cold intolerance, Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire) criteria.

RESULTS: The largest difference between the lengths of the operated and contralateral phalanges was obtained in V-Y plasty. The two-point discrimination sensitivity was the highest in V-Y plasty and a little less with island flap. Cold intolerance was the most common complication of homodigital island flap. Results of the DASH survey was the best in the homodigital island flap and full-thickness skin graft.

CONCLUSION: Based on the analysis of the experience of surgeries to close soft tissue defects of the nail phalanges, the best results were obtained with reverse-flow homodigital island, which is considered as the most versatile and reliable approach.

About the authors

Alexander V. Alexandrov

Filatov Moscow Children’s Clinical Hospital

Email: alexmicrosurg@mail.ru
ORCID iD: 0000-0002-6110-2380
SPIN-code: 5229-0038

Head of the Department of Microsurgery

Russian Federation, 15 Sadovaya-Kudrinskaya str., Moscow, 103001

Pavel V. Goncharuk

Filatov Moscow Children’s Clinical Hospital

Author for correspondence.
Email: gonelpav@rambler.ru
ORCID iD: 0000-0002-9560-037X

surgeon

Russian Federation, 15 Sadovaya-Kudrinskaya str., Moscow, 103001

Lamiya Ya. Idris

N.I. Pirogov Russian National Research Medical University

Email: idrislamiya@mail.ru
ORCID iD: 0000-0002-4902-7939

resident pediatric surgeon

Russian Federation, 15 Sadovaya-Kudrinskaya str., Moscow, 103001

Vsevolod V. Rybchenok

Filatov Moscow Children’s Clinical Hospital; Research Institute of clinical surgery, Pirogov Russian National Research Medical University

Email: sevasurgeon@gmail.com
ORCID iD: 0000-0001-9635-891X
SPIN-code: 2545-8675

Dr. Sci. (Med.)

Russian Federation, 15 Sadovaya-Kudrinskaya str., Moscow, 103001

Alexander A. Smirnov

N.I. Pirogov Russian National Research Medical University

Email: smirnov_aan@bk.ru
ORCID iD: 0000-0002-7274-8291

postgraduate student

Russian Federation, 15 Sadovaya-Kudrinskaya str., Moscow, 103001

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Supplementary files

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2. Fig. 1. Mean difference of the length of the distal phalanges among groups of patients

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3. Fig. 2. Mean values of the two-point discrimination test among groups of patients

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4. Fig. 3. Mean values of cold intolerance among groups of patients

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5. Fig. 4. Mean values of the results of Disabilities of the Arm, Shoulder and Hand questionnaire among groups of patients

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6. Fig. 5. Stages of the surgical operation of the distal phalanx defect coverage in a 7-year-old child using a V-Y flap: a — soft tissue defect of the distal phalanx of the left ring finger; b — scheme of the distal phalanx defect coverage using a V-Y flap; c — appearance of the finger after coverage of defect

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7. Fig. 6. Stages of the surgical operation of the distal phalanx defect coverage in a 14-year-old child using a thenar flap: a — soft tissue defect of the distal phalanx of the left ring finger; b — scheme of the distal phalanx defect coverage using a thenar flap; c — coverage of defect

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8. Fig. 7. Stages of the surgical operation of the distal phalanx defect coverage in a 15-year-old child using a cross-finger flap: a — incomplete distal phalanx amputation of the right ring finger; b — scheme of the distal phalanx defect coverage using a cross-finger flap; c — coverage of defect

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9. Fig. 8. Stages of the surgical operation of the distal phalanx defect coverage in a 15-year-old child using a full-thickness skin graft: a — soft tissue defect of the distal phalanx of the left index finger; b — coverage of defect using a full-thickness skin graft

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10. Fig. 9. Stages of the surgical operation of the distal phalanx defect coverage in a 8-year-old child using a reverse-flow homodigital island flap: a — soft tissue defect of the distal phalanx of the right index finger; b — scheme of the distal phalanx defect coverage using a reverse-flow homodigital island flap; c — coverage of defect

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