A complex soft tissue reconstruction of distal phalanges in children

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.