Pediatric thenar flaps: a modified design, case series and review of the literature

BackgroundFingertip 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.MethodsPediatric thenar flap reconstructions were retrospectively identified from October 2000 to October 2010 at a single institution.ResultsSixteen pediatric patients (eleven male, five female) underwent thenar flap procedures. The average age was 10.8 years (1.1–17.8 years). The average defect size was 1.5 cm × 1.5 cm (1 cm2–2 cm2). Division and inset occurred on average 16 days later (12–24 days). Average follow-up was 6.8 months (4.1–9.6 months). 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 7 mm (6 mm–10 mm) in 10 compliant patients and was grossly intact in all other patients. There were no complications.ConclusionsThe thenar flap is a safe and effective option for pediatric fingertip amputation injuries requiring soft-tissue reconstruction.