Haehnel Ouri, Plancq Marie-Christine, Deroussen Francois, Salon Arielle, Gouron Richard, Klein Céline
Department of Paediatric Orthopaedic Surgery, Amiens University Hospital and Jules Verne University of Picardy, Amiens, France.
Université Paris Descartes, Sorbonne Paris Cité, Department of Pediatric Orthopedics, Hôpital Necker Enfants Malades, Paris, France.
J Hand Surg Am. 2019 Dec;44(12):1097.e1-1097.e6. doi: 10.1016/j.jhsa.2019.02.018. Epub 2019 Apr 17.
Distal finger trauma is one of the most frequent emergencies in children and has the potential for functional and cosmetic damage to the hand. The Atasoy flap (AF) is a vascularized, subcutaneous pedicle V-Y advancement flap used to cover a loss of distal finger substance. Our hypothesis was that the AF is a safe, reliable flap that results in few complications and gives satisfactory functional and cosmetic results in children.
We retrospectively assessed children with distal finger trauma and AF pulp reconstruction in our pediatric orthopedic department between 2008 and 2017. The lesion zone was classified, and we also evaluated necrosis, infection, the shape of the pulp, pulp sensitivity (Weber test), hyponychial scarring, and the presence of a hook nail deformity. Lastly, we compared patients who developed a hook nail with those who did not.
Thirty children were included (mean age at trauma, 6.4 years [range, 1.3-15.7 years]). In 21 cases, the finger damage was located in Ishikawa subzone II. No cases of necrosis or infection were reported. Epicritical tactile sensitivity was good in 20 patients (67%). A hook nail deformity was observed in 15 children (50%) and hyponychial scarring in 22 patients (73%). The pulp had a normal shape in 13 children (43%). The hook nail group displayed more hyponychial scarring, greater nail dystrophy, and lower pulp sensitivity.
The AF yielded contrasting results. High reliability, good coverage, and minimal donor-site morbidity were compromised by suboptimal tip length/shape, nail appearance, and sensitivity.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
手指远端创伤是儿童最常见的急症之一，有可能对手部功能和外观造成损害。阿塔索伊皮瓣（AF）是一种带血管蒂的皮下V-Y推进皮瓣，用于覆盖手指远端组织缺损。我们的假设是，AF是一种安全、可靠的皮瓣，并发症少，能为儿童带来满意的功能和外观效果。
我们回顾性评估了2008年至2017年在我院小儿骨科接受手指远端创伤及AF指腹重建的儿童。对损伤区域进行分类，同时评估坏死、感染、指腹形状、指腹感觉（韦伯试验）、甲床瘢痕形成以及钩甲畸形的情况。最后，我们对出现钩甲的患者和未出现钩甲的患者进行了比较。
共纳入30例儿童（创伤时平均年龄6.4岁[范围1.3 - 15.7岁]）。21例患者手指损伤位于石川分区II。未报告坏死或感染病例。20例患者（67%）的浅感觉良好。15例儿童（50%）观察到钩甲畸形，22例患者（7）出现甲床瘢痕形成。13例儿童（43%）的指腹形状正常。钩甲组甲床瘢痕形成更多、指甲营养不良更严重且指腹感觉更低。
AF产生了不同的结果。高可靠性、良好的覆盖效果以及最小的供区并发症被欠佳的指尖长度/形状、指甲外观和感觉所抵消。
研究类型/证据水平：治疗性IV级。
