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
- Authors: Alexandrov A.V.1, Goncharuk P.V.1, Evdokimov A.N.1, Idris L.Y.2, Smirnov A.A.1, Khagurov R.A.1, Samorukova N.N.1, Alexandrova N.Y.1
-
Affiliations:
- Filatov Moscow Children’s Clinical Hospital
- Russian National Research Medical University
- Issue: Vol 10, No 3 (2022)
- Pages: 277-284
- Section: Clinical cases
- Submitted: 18.05.2022
- Accepted: 20.07.2022
- Published: 13.09.2022
- URL: https://journals.eco-vector.com/turner/article/view/108022
- DOI: https://doi.org/10.17816/PTORS108022
- ID: 108022
Cite item
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.
Full Text
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, MoscowPavel 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, MoscowAlexander N. Evdokimov
Filatov Moscow Children’s Clinical Hospital
Email: pediatrix@yandex.ru
ORCID iD: 0000-0002-9113-3612
MD, surgeon
Russian Federation, MoscowLamiya Ya. Idris
Russian National Research Medical University
Email: idrislamiya@mail.ru
ORCID iD: 0000-0002-4902-7939
MD, PhD student
Russian Federation, MoscowAlexander A. Smirnov
Filatov Moscow Children’s Clinical Hospital
Email: smirnov_aan@bk.ru
ORCID iD: 0000-0002-7274-8291
MD, surgeon
Russian Federation, MoscowRuslan A. Khagurov
Filatov Moscow Children’s Clinical Hospital
Email: dr.khagurov@gmail.com
ORCID iD: 0000-0001-7944-8438
MD, surgeon
Russian Federation, MoscowNina N. Samorukova
Filatov Moscow Children’s Clinical Hospital
Email: ninasolovieva@yandex.ru
MD, surgeon
Russian Federation, MoscowNatalya Y. Alexandrova
Filatov Moscow Children’s Clinical Hospital
Email: docnatali1@yandex.ru
MD, anesthesiologist
Russian Federation, MoscowReferences
- Barbarash NA, Berg MD, Grigor’yev NR, et al. Fiziologiya: Uchebnik dlya studentov lechebnogo i pediatricheskogo fakul’tetov. Ed. by V.M. Smirnov, D.S. Sveshnikov, A.E. Umryukhin. 6th ed. Moscow: Meditsinskoye informatsionnoye agentstvo; 2019. (In Russ.)
- Al-Anazi AF. Fingertip injuries in paediatric patients – experiences at an emergency centre in Saudi Arabia. J Pak Med Assoc. 2013;63(6):675−679.
- Al-Qadhi S, Chan KJ, Fong G, et al. Management of uncomplicated nail bed lacerations presenting to a children’s emergency department. Pediatr Emerg Care. 2011;27(5):379−383. doi: 10.1097/PEC.0b013e318216b22d
- Claudet I, Toubal K, Carnet C, et al. Quand les portes claquent, les doigts craquent! [When doors slam, fingers jam!]. Arch Pediatr. 2007;14(8):958−963. (In French.). doi: 10.1016/j.arcped.2007.03.019
- Doraiswamy NV, Baig H. Isolated finger injuries in children-incidence and aetiology. Injury. 2000;31(8):571−573. doi: 10.1016/s0020-1383(00)00052-8
- Fetter-Zarzeka A, Joseph MM. Hand and fingertip injuries in children. Pediatr Emerg Care. 2002;18(5):341−345. doi: 10.1097/00006565-200210000-00003
- Patel L. Management of simple nail bed lacerations and subungual hematomas in the emergency department. Pediatr Emerg Care. 2014;30(10):742−748. doi: 10.1097/PEC.0000000000000241
- Vadivelu R, Dias JJ, Burke FD, Stanton J. Hand injuries in children: a prospective study. J Pediatr Orthop. 2006;26(1):29−35. doi: 10.1097/01.bpo.0000189970.37037.59
- Allen MJ. Conservative management of finger tip injuries in adults. Hand. 1980;12(3):257−265. doi: 10.1016/s0072-968x(80)80049-0
- Panattoni JB, De Ona IR, Ahmed MM. Reconstruction of fingertip injuries: surgical tips and avoiding complications. J Hand Surg Am. 2015;40(5):1016−1024. doi: 10.1016/j.jhsa.2015.02.010
- Tang JB, Elliot D, Adani R, et al. Repair and reconstruction of thumb and finger tip injuries: a global view. Clin Plast Surg. 2014;41(3):325−359. doi: 10.1016/j.cps.2014.04.004
- Lee KJ, Park I, Roh SK, et al. Simultaneous volar pulp and nail bed reconstruction with the second toe onychocutaneous free flap. Archives of Hand and Microsurgery. 2021;26(2). doi: 10.12790/ahm.21.0085
- Martin-Playa P, Foo A. Approach to fingertip injuries. Clin Plast Surg. 2019;46(3):275−283. doi: 10.1016/j.cps.2019.02.001
- Liu TH, Hsieh MC, Chou PR, Huang SH. Reconstruction for defects of total nail bed and germinal matrix loss with acellular dermal matrix coverage and subsequently skin graft. Medicina (Kaunas). 2020;56(1):17. doi: 10.3390/medicina56010017
- Hwang E, Park BH, Song SY, et al. Fingertip reconstruction with simultaneous flaps and nail bed grafts following amputation. J Hand Surg Am. 2013;38(7):1307−1314. doi: 10.1016/j.jhsa.2013.03.032
- Kusuhara H, Ichinohashi K, Sueyoshi Y, et al. Reconstruction of severely crushed fingertip amputations with basic fibroblast growth factor slow release system. Plast Reconstr Surg Glob Open. 2017;5(6):e1384. doi: 10.1097/GOX.0000000000001384
- Alagoz MS, Uysal CA, Kerem M, Sensoz O. Reverse homodigital artery flap coverage for bone and nailbed grafts in fingertip amputations. Ann Plast Surg. 2006;56(3):279−283. doi: 10.1097/01.sap.0000200086.24613.da