BACKGROUND:Hook nail deformity is one of the widespread post-traumatic deformities of distal phalanges. The affected finger has decreased function and loses its characteristic appearance. Onlyafew publications explored this problem in children. In this study, we presentasurgical correction technique for this deformity by the combination of two existing reconstructive methods, i.e., the antenna procedure and the reverse-flow homodigital island flap. CLINICAL CASES:Aseries of clinical cases of patients aged 3, 5, and 17 years who underwent hook nail deformity correction was analyzed. These children underwent the combination of the antenna procedure and reverse-flow homodigital island flap. In all three cases, the deformities were corrected, andanacceptable appearance, and function of the fingers were achieved. DISCUSSION:Various methods of hook nail deformity correction have proven themselves and affirmed by literature data. The method described herein may be considered reliable, as demonstrated by the clinical cases. CONCLUSIONS:We consider the combination of the antenna procedure and reverse-flow homodigital island flap asajustified method. However, issues raised in this technique require further investigation.
Objective. Hand injuries in children are quite common. Most challenging within plastic and reconstructive surgery/reconstructive microsurgery expertise were there traumatic hand defect and upper extremities open injuries sequels. There were wide variety of reconstruction techniques to deal with hand defects in general and with distal phalanx defects particularly. The core problem is how to make very choice of reconstructive method and technique from diversity of local, regional and distant flaps. 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 actual. A lot of methods of coverage of distal phalanges defects are developed. There is no generally accepted approach or an algorithm in the treatment of adults and children with such type of trauma.Material and methods. In the period from 2018 to 2021 at the Microsurgery Department of N.F. Filatov Moscow Clinical Hospital for Children 152 surgical operations using local (68), regional (72) and distant (12) flaps were performed.Results. All flaps in all patients within our clinical series have survived. There were neither major complication no secondary revisional procedures. Used different flaps in general provided transport of adequate viable donor tissues to recipient areas of critical functional significance. The selection of particular flap we have been making on individual basis mostly depending on type and injury severity, and functional requirement and prognosis.Conclusion. We are considering surgeon’s own experience is main defining factor to make selection of certain method from the diversity of different flaps.
BACKGROUND: The hand and its distal phalanges, especially in children, are among areas mostly exposed to trauma while contacting the environment. Injuries causing loss of soft tissue and bone component are both challenging and interesting. This report presents the treatment results of children with soft tissue and bone defects of distal phalanges, in which reconstructions including combination of regional flaps, bone, and nailbed grafts were performed. CLINICAL CASE: This report presents clinical cases of the surgical treatment of 4- and 6-year-old children with fingertip injuries who underwent reconstructions including the combination of regional flaps, bone, and nailbed grafts. A combination of the scrap graft was performed in the first case with antegrade homodigital island flap and in the second case with thenar flap. The results were assessed 6 and 7 months after surgery. DISCUSSION: The primary aim of the surgical treatment of children with distal phalangeal defects is coverage of those defects. The restoration of the bone component of the defect is recommended to prevent postoperative deformations of the distal phalanges. Fingertip replantation or microsurgical transplantation of vascularized tissue complexes are technically difficult and require thorough care and monitoring of the childs condition in the postoperative period as all these measures may fail. CONCLUSIONS: The possibility to combine the scrap bone and nailbed graft with existing reliable surgical methods open new prospects for the successful treatment of fingertip injuries.
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.
Objective. Damage to peripheral nerves has a strong impact on the life of patients, as the absence during the care provided can lead to disability. It is important to determine the prognostic factors that affect the outcome of the disease.Material and methods. During the initial selection, 1902 publications (PubMed) and 675 results were found using the Google Scholar database. From the initially identified search results, an analysis of 5 papers was carried out.Results. The total number of patients with peripheral nerve injuries of the upper extremities was 120. The average age of patients is (9.1 ± 1.5) years old. The conducted meta-analysis of the difference in the average values of recovery of motor function of peripheral nerves after surgery showed: the final increase in the recovery rate of motor function, depending on age, was 0.47 (0.08–0.87) %, p < 0.02; the final increase in the recovery rate of motor function, depending on the level of damage, was 0.71 (0.27–1.13) %, p < 0.02.Conclusion. The obtained results showed the prognostic value of such indicators as age at the time of surgery and the level of damage. Thus, we can confidently say that the smaller the age of the child and the more distal the level of damage, the better results can be expected after surgery.
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