Long-term outcomes of homodigital neurovascular island flap reconstruction of fingertip injuries in children

Abstract

We evaluated the long-term functional and cosmetic results of homodigital neurovascular island flap (NIF) used to reconstruct extensive pulp defects with bone exposure in children. Twenty-three children (mean age 4.8 years, range 1-10 years) with fingertip injuries were reconstructed with a pedicled homodigital NIF and evaluated in terms of sensation quality, cold intolerance, scar formation, nail deformity, range of motion and overall finger length at a mean follow up of 7.8 years (range 2-13). Eleven patients reported cold sensitivity in the operated fingertip, and 15 presented with hook nail deformities at the final follow-up. The total active motion of the injured finger was significantly lower than that of the uninjured side (p < 0.001). NIFs is a safe, reliable reconstructive treatment for fingertip loss in children, but commonly encountered issues in the long term include an extension lag of the interphalangeal joints, hook nail deformities and cold intolerance. Level of evidence: IV.

Keywords: Children; fingertip defect; fingertip injuries; homodigital neuvascular island flap.

Figure 1.

Lim’s classification for degree of hook nail deformity (Lim et al., 2008).

Figure 2.

The preoperative (a), intraoperative (b) and early postoperative (c) pictures of a patient with a fingertip injury with exposed distal phalanx and intact nail matrix.

Figure 3.

Photographs taken in the third postoperative year showed no atrophy at the reconstructed pulp (a), no limitation of flexion and extension (b) but a hook nail deformity of the fingernail (c).