Hong Min Ki, Lee Dong Chul, Choi Min Suk, Koh Sung Hoon, Kim Jin Soo, Roh Si Young, Lee Kyung Jin
Department of Plastic and Reconstructive Surgery, Gwangmyeong Sungae Hospital, Gwangmyeong, Korea.
Arch Plast Surg. 2020 Nov;47(6):590-596. doi: 10.5999/aps.2020.01137. Epub 2020 Nov 15.
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.
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.
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.
Partial second toe pulp free flaps are an excellent option for fingertip reconstruction in young children, as well as in adults.
部分第二趾趾腹游离皮瓣的引入为成人指尖重建带来了更好的美学和功能效果。因各种原因接受指尖截肢的儿童重建选择有限。传统治疗可能会使手指缩短，导致美观和功能不佳。我们报告了18年来在幼儿患者中使用部分第二趾趾腹游离皮瓣进行指尖重建的经验。
回顾性分析2001年至2018年期间接受部分第二趾趾腹游离皮瓣指尖重建的儿童的病历。手术操作与成人相同，只是使用了11-0尼龙缝线。记录患者的人口统计学数据、血管大小、皮瓣尺寸、远节指骨长度以及长期随访过程中的功能结果。采用学生t检验、曼-惠特尼U检验和皮尔逊相关分析进行统计学分析。
确定了17例患者（平均年龄3.0岁）的18个趾腹皮瓣。所有皮瓣均存活，无任何严重并发症。在长期随访中，皮瓣覆盖的远节指骨随正常发育生长。供区无并发症，所有儿童均能顺利适应日常生活。在两点辨别试验中，指尖感觉恢复到与对侧手指几乎相同的水平。
部分第二趾趾腹游离皮瓣是幼儿以及成人指尖重建的极佳选择。
