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V – Y Advancement Flap Versus Cross Finger Flap in Pediatric Hand Trauma - Abstract

Prisca Radu-Alexandru, Toth Tamas, Gozar Horea



Introduction: Fingertip injuries are the most common injuries in pediatric hand trauma. The goal in fingertip amputation reconstruction is to cover the defect, establish maximum tactile gnosis, and protect the joint function and none the less to obtain a satisfactory cosmetic appearance. The plane of the amputation and the condition of the tissue at the injury site help to determine the best repair technique.

Materials and Methods: Thirty pediatric patients underwent fingertip reconstruction using the V-Y advancement flap and cross finger flap techniques at the Department of Pediatric Surgery in Târgu Mureş between January 2015 and December 2016. The used technique was chosen according to the nature of the injury, the size and condition of the defect, the affected fingertip, the plane and the zone of the traumatism. During the follow up visit the two point discrimination test was determined. The parents compared the cosmetic results with the contralateral fingertip and they rated it on a 1-10 scale.

Results: Cross finger flap was used in 14 cases and V-Y advancement flap in 16 cases. We corrected with cross finger flap technique 14 volar and 1 dorsal fingertip injuries. The operation average time was 83.21 minutes. The cosmetic outcome in this group was 8.28. Mostly dorsal (n=9) and transverse (n=7) injuries were corrected by V-Y advancement flap. The surgery to cover the deficiency took 36.56 minutes. A better cosmetic result was found in this group, the average rate was 9.37. There was a significant correlation between the plane of the traumatism and the cosmetic outcome of the operation. The best outcomes were found in transverse injuries. The quicker hospital presentation showed the better cosmetic outcomes at the 0.01 significance level.

Conclusion: The V-Y advancement flap can be used with a high liability in dorsal and transverse injuries. Cross finger flap is used more often in volar traumatism. We cannot apply an algorithm for the elective approach.

Keywords: V-Y advancement flap, cross finger flap, hand trauma


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