The Use of Mitten-Shaped Thin Abdominal Flap for the Coverage of Extensive Compound Dorsal Hand Defect in a Pediatric Patient

Abstract

Background: Severe hand trauma in small children has special social, psychological, aesthetic and functional implications that mandate comprehensive treatment strategies. Because of the miniaturized size of the limbs and the incautiousness of the little kids, the injury tends to have a substantial severity and extent. Moreover, the physicians will encounter considerable difficulties while attempting the reconstructive task and implementing the post operative care, also owing to the tiny structural components and the uncooperativeness of the toddlers. Aim and Objectives: To reconstruct the severe hand injury in Pediatrics by using the abdominal flap was an efficient and safety method. Materials and Methods: This report describes an 18-month-old boy who sustained 3rd degree contact burn over his left dorsal hand with multiple extensor tendon loss, joint and bone exposure, and large skin defect due to autonomic cup-sealing machine injury. He received abdominal flap transfer for wound coverage in conjunction with immediate tendon and lateral bands reconstruction using tensor fascia lata graft. A whole body spica was used to prevent premature detachment of the limb from the abdomen donor site during the two weeks period of immobilization. A special ”mitten like” flap design was utilized, which served to ensure a stable limb anchorage and enable maximal contact surface between the two parties with minimal enrollment of unnecessary donor tissue. An optimal thinning of the flap thickness can be achieved without safety concern. The flap was divided two weeks later and two more surgeries were conducted subsequently to separate the syndactylous fingers. A reasonable final functional result was obtained without significant donor site morbidity. The rational and technical details as well as the special measure of postoperative immobilization were described in this article. Results: No flap partial necrosis or total necrosis was found in each surgery including of reconstructive and division operation. No donor site co-morbidity was noted. Three hundred eighteen days after abdominal flap surgery, or 155 days following complete flap division, no significant complication related either to the donor or recipient sites and an acceptable functional performance is achieved. Conclusion: The method of traditional abdominal flap transfer, is easy to execute, highly accountable, vastly flexible and versatile in flap design, and would be particularly valuable for young aged individual.