Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
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Partial second toe pulp free flaps in early childhood

  • Hong, Min Ki (Department of Plastic and Reconstructive Surgery, Gwangmyeong Sungae Hospital) ;
  • Lee, Dong Chul (Department of Plastic and Reconstructive Surgery, Gwangmyeong Sungae Hospital) ;
  • Choi, Min Suk (Department of Plastic and Reconstructive Surgery, Gwangmyeong Sungae Hospital) ;
  • Koh, Sung Hoon (Department of Plastic and Reconstructive Surgery, Gwangmyeong Sungae Hospital) ;
  • Kim, Jin Soo (Department of Plastic and Reconstructive Surgery, Gwangmyeong Sungae Hospital) ;
  • Roh, Si Young (Department of Plastic and Reconstructive Surgery, Gwangmyeong Sungae Hospital) ;
  • Lee, Kyung Jin (Department of Plastic and Reconstructive Surgery, Gwangmyeong Sungae Hospital)
  • Received : 2020.06.24
  • Accepted : 2020.09.29
  • Published : 2020.11.15
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Abstract

Background The introduction of the partial second toe pulp free flap has enabled superior aesthetic and functional results for fingertip reconstruction in adults. Children undergoing fingertip amputation for various reasons have limited options for reconstruction. Conventional treatment could shorten the finger, leading to poor cosmesis and function. We report 18 years of our experiences with fingertip reconstruction using partial second toe pulp free flaps in patients in early childhood. Methods Medical charts of children who had undergone fingertip reconstruction using partial second toe pulp free flaps from 2001 to 2018 were retrospectively reviewed. The surgical procedures were identical to those for adults, except for the usage of 11-0 nylon sutures. Patients' demographic data, vessel size, flap dimensions, length of the distal phalanx, and functional outcomes over the course of long-term follow-up were documented. The statistical analysis was performed with the Student t-test, the Mann-Whitney U test, and Pearson correlation analysis. Results Eighteen toe pulp flaps in 17 patients (mean age, 3.0 years) were identified. All the flaps survived without any major complications. In long-term follow-up, the flap-covered distal phalanges showed growth in line with regular development. There was no donor-site morbidity, and all children adapted to daily life without any problems. In two-point discrimination tests, the fingertip sensation recovered to almost the same level as that in the contralateral finger. Conclusions Partial second toe pulp free flaps are an excellent option for fingertip reconstruction in young children, as well as in adults.

Keywords

References

  1. Macgregor DM, Hiscox JA. Fingertip trauma in children from doors. Scott Med J 1999;44:114-5. https://doi.org/10.1177/003693309904400406
  2. Doraiswamy NV, Baig H. Isolated finger injuries in children: incidence and aetiology. Injury 2000;31:571-3. https://doi.org/10.1016/S0020-1383(00)00052-8
  3. Menckhoff C, Kimpel N, Kaminstein D. Pediatric hand injuries, part II: lacerations, amputations, bites, and nail-bed injuries. Pediatr Emerg Med Rep 2009;14:121-31.
  4. Gellman H. Fingertip-nail bed injuries in children: current concepts and controversies of treatment. J Craniofac Surg 2009;20:1033-5. https://doi.org/10.1097/SCS.0b013e3181abb1b5
  5. Martin C, Gonzalez del Pino J. Controversies in the treatment of fingertip amputations: conservative versus surgical reconstruction. Clin Orthop Relat Res 1998;(353):63-73.
  6. Kliegman R, Stanton B, Behrman RE, et al. Nelson textbook of pediatrics. 20th ed. Philadelphia: Elsevier; 2016.
  7. Jeon BJ, Yang JW, Roh SY, et al. Microsurgical reconstruction of soft-tissue defects in digits. Injury 2013;44:356-60. https://doi.org/10.1016/j.injury.2013.01.021
  8. Lee DC, Kim JS, Ki SH, et al. Partial second toe pulp free flap for fingertip reconstruction. Plast Reconstr Surg 2008;121:899-907. https://doi.org/10.1097/01.prs.0000299945.03655.0d
  9. Canales F, Lineaweaver WC, Furnas H, et al. Microvascular tissue transfer in paediatric patients: analysis of 106 cases. Br J Plast Surg 1991;44:423-7. https://doi.org/10.1016/0007-1226(91)90200-4
  10. Upton J, Guo L. Pediatric free tissue transfer: a 29-year experience with 433 transfers. Plast Reconstr Surg 2008;121:1725-37. https://doi.org/10.1097/PRS.0b013e31816c3b81
  11. Aboelatta YA, Aly HM. Free tissue transfer and replantation in pediatric patients: technical feasibility and outcome in a series of 28 patients. J Hand Microsurg 2013;5:74-80. https://doi.org/10.1007/s12593-013-0101-7
  12. Foucher G, Boulas HJ, Braga Da Silva J. The use of flaps in the treatment of fingertip injuries. World J Surg 1991;15:458-62. https://doi.org/10.1007/BF01675641
  13. McGregor IA. Flap reconstruction in hand surgery: the evolution of presently used methods. J Hand Surg Am 1979;4:1-10. https://doi.org/10.1016/S0363-5023(79)80097-0
  14. Rockwell WB, Lister GD. Soft tissue reconstruction: coverage of hand injuries. Orthop Clin North Am 1993;24:411-24. https://doi.org/10.1016/S0030-5898(20)31816-2
  15. Akcal A, Karsidag S, Sucu DO, et al. Microsurgical reconstruction in pediatric patients: a series of 30 patients. Ulus Travma Acil Cerrahi Derg 2013;19:411-6. https://doi.org/10.5505/tjtes.2013.09515
  16. Kim HS, Lee DC, Kim JS, et al. Donor-site morbidity after partial second toe pulp free flap for fingertip reconstruction. Arch Plast Surg 2016;43:66-70. https://doi.org/10.5999/aps.2016.43.1.66
  17. Nunley JA, Spiegl PV, Goldner RD, et al. Longitudinal epiphyseal growth after replantation and transplantation in children. J Hand Surg Am 1987;12:274-9. https://doi.org/10.1016/S0363-5023(87)80288-5
  18. Cho JY, Suh HS, Hong JP. Do skin perforator flaps accommodate foot growth in children after reconstruction? J Reconstr Microsurg 2016;32:650-6. https://doi.org/10.1055/s-0036-1584806