Barr Jason S, Chu Michael W, Thanik Vishal, Sharma Sheel
Institute of Reconstructive Plastic Surgery, Department of Plastic and Reconstructive Surgery, New York University Medical Center, New York, NY, USA.
Institute of Reconstructive Plastic Surgery, Department of Plastic and Reconstructive Surgery, New York University Medical Center, New York, NY, USA.
J Pediatr Surg. 2014 Sep;49(9):1433-8. doi: 10.1016/j.jpedsurg.2013.11.066. Epub 2013 Nov 28.
Fingertip injuries are extremely common in children, and severe trauma with pulp loss requires soft-tissue reconstruction to restore length, bulk, and sensibility. The thenar flap is a well-described technique but there are few reports of its use in pediatric patients.
Pediatric thenar flap reconstructions were retrospectively identified from October 2000 to October 2010 at a single institution.
Sixteen pediatric patients (eleven male, five female) underwent thenar flap procedures. The average age was 10.8years (1.1-17.8years). The average defect size was 1.5cm×1.5cm (1cm(2)-2cm(2)). Division and inset occurred on average 16days later (12-24days). Average follow-up was 6.8months (4.1-9.6months). The average total active range of motion (TAM) in flexion was 248° (235°-260°) [normal maximum: 260°]. All patients had 85° metacarpophalangeal joint (MCPJ) range of motion (ROM) [normal maximum: 85°]. The average proximal interphalangeal joint (PIPJ) ROM was 103° (95°-110°) [normal maximum: 110°] in flexion, and an average 60° distal interphalangeal (DIPJ) ROM (55°-65°) [normal maximum: 65°] in flexion. Objective sensibility in the flap was ascertained as an average static two-point discrimination of 7mm (6mm-10mm) in 10 compliant patients and was grossly intact in all other patients. There were no complications.
The thenar flap is a safe and effective option for pediatric fingertip amputation injuries requiring soft-tissue reconstruction.
指尖损伤在儿童中极为常见，伴有指腹缺损的严重创伤需要进行软组织重建以恢复长度、体积和感觉功能。大鱼际皮瓣是一种广为人知的技术，但在儿科患者中的应用报道较少。
回顾性分析2000年10月至2010年10月在单一机构进行的儿科大鱼际皮瓣重建手术。
16例儿科患者（11例男性，5例女性）接受了大鱼际皮瓣手术。平均年龄为10.8岁（1.1 - 17.8岁）。平均缺损面积为1.5cm×1.5cm（1cm² - 2cm²）。平均在16天后（12 - 24天）进行断蒂和植入。平均随访6.8个月（4.1 - 9.6个月）。平均屈曲时的总主动活动度（TAM）为248°（235° - 260°）[正常最大值：260°]。所有患者掌指关节（MCPJ）活动度（ROM）均为85°[正常最大值：85°]。近端指间关节（PIPJ）平均屈曲ROM为103°（95° - 110°）[正常最大值：110°]，远端指间关节（DIPJ）平均屈曲ROM为60°（55° - 65°）[正常最大值：65°]。10例配合的患者皮瓣的客观感觉功能经测定平均静态两点辨别觉为7mm（6mm - 10mm），其他所有患者感觉功能大致正常。无并发症发生。
对于需要软组织重建的儿科指尖离断伤，大鱼际皮瓣是一种安全有效的选择。
