{"title":"Fingertip amputations in children: Atasoy flap's indications and limitations.","authors":"Raphaël Nguyen, Jean-Gabriel Delvaque, Virginie Mas, Brice Ilharreborde, Pascal Jehanno","doi":"10.1016/j.otsr.2024.103954","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>The Atasoy flap is considered simple and reliable for covering distal digital defects in adults. Various studies in children have shown more contrasting results, particularly in terms of aesthetics and function. The aim of this study is to evaluate the long-term results of this flap specifically in children, in order to determine its limitations and indications.</p><p><strong>Hypothesis: </strong>The Atasoy flap is reliable and reproducible for coverage of distal digital substance loss up to zone 2 in children.</p><p><strong>Materials and methods: </strong>Fifty-six children who benefited from an Atasoy flap operated on between January 2017 and January 2020 were included. Lesion area, operative technique, postoperative complications (infection, healing difficulties, necrosis), and ultimately nail appearance, cold intolerance or finger pain, finger eviction, extension defect, and final parental satisfaction were analyzed.</p><p><strong>Results: </strong>Forty-nine children were evaluated with a mean follow-up of 18 months (min = 3 months, max = 38 months, SD = 11.3 months). Eighteen children had a hook nail, resulting in 6 of them having their finger excluded. The majority of hook nails were found in zone III and in proximal zone II lesions (12 cases). Eighty-nine percent of children with distal suture fixation to the nail bed (8 children) had this complication. Cold intolerance was present in 9 children. There were no cases of extension failure or early post-operative complications. Final parent satisfaction was 9.1/10 (min = 5, max = 10, SD = 1.3).</p><p><strong>Conclusion: </strong>The Atasoy flap in children appears reliable for covering loss of distal digital substance. The main complication is the occurrence of hook nails. Compliance with its indications (transverse substance loss not exceeding the proximal third of zone II) and a precise surgical technique (distal needle fixation without suturing to the nail bed, deep flap lift, non-closure of the donor site) help limit this risk.</p><p><strong>Level of evidence: </strong>IV; retrospective study.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":null,"pages":null},"PeriodicalIF":2.3000,"publicationDate":"2024-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Orthopaedics & Traumatology-Surgery & Research","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.otsr.2024.103954","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 0
Abstract
Introduction: The Atasoy flap is considered simple and reliable for covering distal digital defects in adults. Various studies in children have shown more contrasting results, particularly in terms of aesthetics and function. The aim of this study is to evaluate the long-term results of this flap specifically in children, in order to determine its limitations and indications.
Hypothesis: The Atasoy flap is reliable and reproducible for coverage of distal digital substance loss up to zone 2 in children.
Materials and methods: Fifty-six children who benefited from an Atasoy flap operated on between January 2017 and January 2020 were included. Lesion area, operative technique, postoperative complications (infection, healing difficulties, necrosis), and ultimately nail appearance, cold intolerance or finger pain, finger eviction, extension defect, and final parental satisfaction were analyzed.
Results: Forty-nine children were evaluated with a mean follow-up of 18 months (min = 3 months, max = 38 months, SD = 11.3 months). Eighteen children had a hook nail, resulting in 6 of them having their finger excluded. The majority of hook nails were found in zone III and in proximal zone II lesions (12 cases). Eighty-nine percent of children with distal suture fixation to the nail bed (8 children) had this complication. Cold intolerance was present in 9 children. There were no cases of extension failure or early post-operative complications. Final parent satisfaction was 9.1/10 (min = 5, max = 10, SD = 1.3).
Conclusion: The Atasoy flap in children appears reliable for covering loss of distal digital substance. The main complication is the occurrence of hook nails. Compliance with its indications (transverse substance loss not exceeding the proximal third of zone II) and a precise surgical technique (distal needle fixation without suturing to the nail bed, deep flap lift, non-closure of the donor site) help limit this risk.
简介阿塔索皮瓣被认为是覆盖成人远端数字缺损的简单而可靠的方法。对儿童进行的多项研究显示，其结果反差较大，尤其是在美学和功能方面。本研究旨在评估该皮瓣在儿童中的长期效果，以确定其局限性和适应症：假设：阿塔索伊皮瓣在覆盖儿童第2区以内的远端数字物质缺失方面具有可靠性和可重复性：纳入2017年1月至2020年1月期间接受阿塔索皮瓣手术的56名儿童。对病变面积、手术技术、术后并发症（感染、愈合困难、坏死）以及最终的指甲外观、不耐寒或手指疼痛、手指外翻、伸展缺损和家长最终满意度进行了分析：49名儿童接受了评估，平均随访时间为18个月（最小3个月，最大38个月，SD=11.3个月）。18名儿童患有钩甲，其中6名儿童的手指被切除。大多数钩状甲出现在 III 区和 II 区病变近端（12 例）。在远端缝合固定甲床的患儿（8 例）中，有 89% 出现了这种并发症。9名患儿出现不耐寒症状。没有出现延伸失败或术后早期并发症。最终家长满意度为9.1/10（最低=5，最高=10，SD=1.3）：结论：在儿童中使用阿塔索皮瓣覆盖远端数字物质缺失似乎是可靠的。结论：在儿童中使用阿塔索皮瓣覆盖远端数字物质缺失是可靠的，主要并发症是出现钩状钉。遵守其适应症（横向物质缺失不超过II区近端三分之一）和精确的手术技巧（远端针固定而不缝合甲床、深层皮瓣掀起、不封闭供区）有助于限制这种风险：证据级别：IV；回顾性研究。
期刊介绍：
Orthopaedics & Traumatology: Surgery & Research (OTSR) publishes original scientific work in English related to all domains of orthopaedics. Original articles, Reviews, Technical notes and Concise follow-up of a former OTSR study are published in English in electronic form only and indexed in the main international databases.
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