title: Pediatric thenar flaps: a modified design, case series and review of the literature.
abstract: BACKGROUND
  Fingertip 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.
  
  
  METHODS
  Pediatric thenar flap reconstructions were retrospectively identified from October 2000 to October 2010 at a single institution.
  
  
  RESULTS
  Sixteen pediatric patients (eleven male, five female) underwent thenar flap procedures. The average age was 10.8years (1.1-17.8years). The average defect size was 1.5cm×1.5cm (1cm(2)-2cm(2)). Division and inset occurred on average 16days later (12-24days). Average follow-up was 6.8months (4.1-9.6months). 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 7mm (6mm-10mm) in 10 compliant patients and was grossly intact in all other patients. There were no complications.
  
  
  CONCLUSIONS
  The thenar flap is a safe and effective option for pediatric fingertip amputation injuries requiring soft-tissue reconstruction.
authors.affiliation: Institute of Reconstructive Plastic Surgery, Department of Plastic and Reconstructive Surgery, New York University Medical Center, New York, NY, USA. Electronic address: jason.barr@nyumc.org.
authors.forename: Jason S
authors.initials: JS
authors.lastname: Barr
authors.affiliation: Institute of Reconstructive Plastic Surgery, Department of Plastic and Reconstructive Surgery, New York University Medical Center, New York, NY, USA.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Chu
authors.affiliation: Institute of Reconstructive Plastic Surgery, Department of Plastic and Reconstructive Surgery, New York University Medical Center, New York, NY, USA.
authors.forename: Vishal
authors.initials: V
authors.lastname: Thanik
authors.affiliation: Institute of Reconstructive Plastic Surgery, Department of Plastic and Reconstructive Surgery, New York University Medical Center, New York, NY, USA.
authors.forename: Sheel
authors.initials: S
authors.lastname: Sharma
mesh_terms: D000293:Adolescent; D000673:Amputation, Traumatic / Q000503:physiopathology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005383:Finger Injuries / Q000503:physiopathology / Q000601:surgery*; D005385:Fingers / Q000502:physiology / Q000601:surgery; D006801:Humans; D007223:Infant; D008297:Male; D009068:Movement; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013524:Surgical Flaps
keywords: Amputation; Fingertip; Injury; Pediatric; Reconstruction; Thenar flap