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Pediatric Thenar Flaps: a case series
Michael W. Chu, MD; Jason S. Barr, BA; Vishal Thanik, MD; Jamie P. Levine; Sheel Sharma, MD;
New York University School of Medicine

Introduction: Fingertip injuries are a common hand injury in children. Severe traumas with finger pulp loss require soft-tissue reconstruction to restore length and bulk. The thenar flap is a well-described technique but there is limited literature in its application for pediatric patients. We report a case series of a modified proximally-based thenar flap in pediatric fingertip injuries.

Methods: All thenar flap reconstructions were retrospectively identified in an IRB approved study, from October 2000 to October 2010, at a single institution. Patients younger than 18 years were included, and patients with incomplete data were excluded. The operative course, follow-up, outcomes, and any complications were reviewed.

Results: A total of twelve patients (nine male and three female) underwent thenar flap procedures. The average age was 10.6-years-old (1.1–17.8 years). Mechanism of injury was crush injuries in eleven patients and a knife injury in one. The average defect size was 1.38 x 1.38 cm (1cm–2cm) and all patients underwent a two-stage thenar flap. Division and inset occurred on average 17 days later (13–24 days). The reconstructed digit was the fourth digit in six patients, the third digit three patients, and the second digit in three patients. Average follow-up was 3.9 months (2.1–5.8 months). The proximal and distal interphalangeal joint range of motion was reported to be 78.8° (70–90°) and 40.0° (35–45°), respectively. The average extensor lag at the PIP was 3.3°, with 10° lag in two patients and 5° lag in four patients. Objective sensibility testing is difficult in the pediatric population, but was grossly intact in all patients and all parents reported normal use of the finger. There were no donor site morbidities, and no post-operative interphalangeal joint contractures, cold intolerance, or other complications.

Conclusion: The thenar flap can provide subcutaneous tissue for bulk and contour for severe fingertip pulp injuries. The disadvantages of the thenar flap are that it is a two-staged procedure requiring two anesthetics, frequent local wound care, and hand immobilization. The thenar flap has not been a popular reconstruction for pediatric fingertip injuries for these reasons. However in our case series, there were no anesthetic or surgical complications, post-operative interphalangeal joint contractures, or donor site morbidity. All patients had full recovery of hand function without limitations. We report a case series of twelve patients with two-staged thenar flap reconstruction as a safe and effective reconstructive option for severe fingertip injuries in pediatric patients.

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