Pediatric Traumatology, Orthopaedics and Reconstructive SurgeryPediatric Traumatology, Orthopaedics and Reconstructive SurgeryОртопедия, травматология и восстановительная хирургия детского возрастаPediatric Traumatology, Orthopaedics and Reconstructive Surgery2309-39942410-8731Eco-Vector5705910.17816/PTORS57059Clinical casesКлинические случаиClinical casesResearch ArticleFingertip defects coverage using reverse-flow homodigital island flapsЗакрытие дефектов ногтевых фаланг пальцев кисти у детей с помощью островковых реверсивных гомодигитальных лоскутовhttps://orcid.org/0000-0002-6110-23805229-0038AlexandrovAlexander V.АлександровАлександр Владимирович
Russian Federation
alexmicrosurg@mail.ruhttps://orcid.org/0000-0002-7274-8291SmirnovAlexander A.СмирновАлександр Андреевич
Russian Federation

MD, PhD student

аспирант

smirnov_aan@bk.ruhttps://orcid.org/0000-0002-9560-037XGonchrukPavel V.ГончарукПавел Викторович
Russian Federation
goncharukpavel@yandex.ruFilatov Moscow Children’s Clinical HospitalДетская городская клиническая больница им. Н.Ф. ФилатоваRussian National Research Medical UniversityРоссийский национальный исследовательский медицинский университет им. Н.И. ПироговаFilatov Moscow Children’s Clinical HospitalДетская городская клиническая больница им. Н.Ф. ФилатоваRussian National Research Medical UniversityРоссийский национальный исследовательский медицинский университет им. Н.И. Пирогова0606202129062021922212282812202012042021Copyright ©; 2021, Alexandrov A.V., Smirnov A.A., Gonchruk P.V.Copyright ©; 2021, Александров А.В., Смирнов А.А., Гончарук П.В.Copyright ©; 2021, Alexandrov A., Smirnov A., Gonchruk P.2021Alexandrov A.V., Smirnov A.A., Gonchruk P.V.Александров А.В., Смирнов А.А., Гончарук П.В.Alexandrov A., Smirnov A., Gonchruk P.http://creativecommons.org/licenses/by/4.0https://journals.eco-vector.com/turner/article/view/57059

BACKGROUND: The hand has always been a highly organized tool in human’s daily and professional activity. Distal phalanges are most commonly exposed to trauma, which often cause defects that need to be covered through plastic surgery. One of the most reliable and universal methods for fingertip reconstruction is the reverse-flow homodigital island flap.

CLINICAL CASES: This series of clinical cases describe three children aged 7, 8, and 11 years who underwent coverage of fingertip defects with the reverse-flow homodigital island flap. In all cases, mechanisms of injury were associated with crushing and rupture of soft tissues. All children underwent coverage of fingertip defects with the reverse-flow homodigital island flap. In the first case, evaluation results at 6 months after surgery revealed 4 mm in the Weber’s test and phalanx length deficit of 2 mm. In the second case, the assessment performed 1 month after surgery revealed 5 mm in the Weber’s test and the length of the operated phalanx corresponds to the contralateral one. In the third case, results of the 2-month observation period revealed 4 mm in the Weber’s test and lengths of the operated and contralateral phalanges were the same.

DISCUSSION: The reverse-flow homodigital island flaps have irrefragable advantages among methods of surgical reconstruction of soft tissues of distal phalanges. These are single-stage reconstruction techniques that can possibly replenish sufficient amounts of soft tissues to the defect. A literature data analysis of the outcomes of the fingertip reconstruction through the reverse-flow homodigital island flaps revealed good and satisfactory results.

CONCLUSIONS: The method of the reverse-flow homodigital island flap has potential to take a significant place in pediatric traumatology and reconstructive surgery.

Обоснование. Кисть является высокоорганизованным инструментом человека в повседневной и профессиональной активности. Дистальные фаланги пальцев кисти наиболее часто подвергаются травмам, в результате чего нередко возникают их дефекты, по поводу которых приходится осуществлять пластическое закрытие. Один из наиболее надежных и универсальных методов реконструкции — использование островкового гомодигитального лоскута на реверсивном кровотоке.

Клинические наблюдения. Описаны клинические случаи закрытия дефектов мягких тканей ногтевых фаланг пальцев кисти у детей 7, 8 и 11 лет. Во всех случаях механизм травмы был связан со сдавлением и с отрывом мягких тканей пальца. Всем детям выполнено закрытие дефектов с помощью реверсивных островковых лоскутов пальцевых артерий. Результаты оценены в одном случае через 6 мес.: тест Вебера — 4 мм, дефицит длины фаланги — 2 мм. Во втором случае при оценке через месяц получены следующие результаты: тест Вебера — 5 мм, длина оперированной фаланги соответствует контралатеральной. В третьем случае срок наблюдения составил 2 мес.: тест Вебера — 4 мм, длина фаланги аналогична контралатеральной.

Обсуждение. Среди множества методов хирургической реконструкции мягких тканей ногтевых фаланг пальцев кисти у детей островковые гомодигитальные лоскуты пальцевых артерий на реверсивном кровотоке обладают неоспоримыми преимуществами. Это одноэтапность реконструкции и возможность привнесения достаточного объема мягких тканей в зону дефекта. При анализе исходов применения островковых лоскутов, по данным литературы, выявлены хорошие и удовлетворительные результаты.

Заключение. Метод островкового реверсивного гомодигитального лоскута может занимать значимое место в детской травматологии и реконструктивной хирургии.

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