Two clinical cases of the reconstruction of distal phalanges of hand in children by combination of the regional flap and scrap bone and nailbed graft

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Abstract

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 child’s 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.

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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

MD, Head of the Department of Reconstructive Microsurgery

Russian Federation, Moscow

Pavel V. Goncharuk

Filatov Moscow Children’s Clinical Hospital

Author for correspondence.
Email: goncharukpavel@yandex.ru
ORCID iD: 0000-0002-9560-037X
SPIN-code: 6801-9875

MD, surgeon

Russian Federation, Moscow

Alexander N. Evdokimov

Filatov Moscow Children’s Clinical Hospital

Email: pediatrix@yandex.ru
ORCID iD: 0000-0002-9113-3612

MD, surgeon

Russian Federation, Moscow

Lamiya Ya. Idris

Russian National Research Medical University

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

MD, PhD student

Russian Federation, Moscow

Alexander A. Smirnov

Filatov Moscow Children’s Clinical Hospital

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

MD, surgeon

Russian Federation, Moscow

Ruslan A. Khagurov

Filatov Moscow Children’s Clinical Hospital

Email: dr.khagurov@gmail.com
ORCID iD: 0000-0001-7944-8438

MD, surgeon

Russian Federation, Moscow

Nina N. Samorukova

Filatov Moscow Children’s Clinical Hospital

Email: ninasolovieva@yandex.ru

MD, surgeon

Russian Federation, Moscow

Natalya Y. Alexandrova

Filatov Moscow Children’s Clinical Hospital

Email: docnatali1@yandex.ru

MD, anesthesiologist

Russian Federation, Moscow

References

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Supplementary files

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2. Fig. 1. Boy, 4 years old. Divulsion of the distal part of the nail phalanx of finger II of the right hand: a, soft tissue defect; b, radiographs of finger II of the child’s right hand on hospital admission; c, defect closure using a combination of a graft and a scrap graft; d, view of the finger 7 months after the surgery; e, radiographs of finger II of the right hand 7 months after the surgery

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3. Fig. 2. Allen’s classification of defects in the nail phalanges of the fingers

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4. Fig. 3. Schematic representation of the nail phalanx reconstruction through a combination of an islet homodigital flap on reverse blood flow and a scrap bone graft and a nail bed of the dissected fragment

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5. Fig. 4. A 6-year-old boy with divulsion of the distal nail phalanx of finger II of the left hand: a, transverse tissue defect; b, radiographs of finger II of the left hand; c, view of the finger after stage I; b, radiographs of finger II of the left hand 6 months after stage 2 of surgery; c, view of the finger 6 months after stage 2 of surgery

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Copyright (c) 2022 Alexandrov A.V., Goncharuk P.V., Evdokimov A.N., Idris L.Y., Smirnov A.A., Khagurov R.A., Samorukova N.N., Alexandrova N.Y.

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