Arch Hand Microsurg.  2020 Dec;25(4):287-291. 10.12790/ahm.20.0052.

Kirschner Wire Fixation for Immobilization of the Thenar Flap in an Uncooperative Pediatric Patient: A Case Report

• Yoo H
• Kim Y
• Kwon ST
• Kim BJ

• KMID: 2508942
• DOI: http://doi.org/10.12790/ahm.20.0052

Abstract

Thenar flap is a commonly used operational method in fingertip reconstruction. It should be maintained for two to three weeks before flap division until the neovascularization is established from the fingertip to the flap. However, immobilization between two stages of operation is challenging especially in uncooperative pediatric patients. A 47-month-old female with a ring fingertip amputation underwent soft tissue reconstruction with thenar flap. Two days postoperatively, the flap’s proximal margin was found disrupted. Flap revision was performed, followed by applying a trans-phalangeal Kirschner wire (K-wire) between the thumb proximal phalanx and ring finger middle phalanx. The flap was successfully divided two weeks after the original operation. The result was aesthetically pleasing, and no complication was observed, including dehiscence, necrosis, limitation of range of motion, and visible scar of the pinning sites. In conclusion, K-wire fixation is a safe and effective method to immobilize thenar flap in uncooperative pediatric patients.

Keyword

Thenar flap; Kirschner wire; Fingertip; Immobilization; Pediatrics

Figure

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  Fig. 1. (A) Preoperative photograph of a 47-month-old female with a soft tissue defect (Ishikawa zone 1) and exposure of the distal tip of distal phalangeal bone at right ring finger. (B) Preoperative X-ray shows a minor fracture line in the distal phalangeal bone.

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  Fig. 2. (A) Immediate postoperative photograph of reconstruction with thenar flap. (B) The proximal margin of the flap was found disrupted 2 days after the first operation.

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  Fig. 3. (A) Immediate postoperative photograph after applying a Kirschner wire between the shafts of the ring finger middle phalangeal bone and the thumb proximal phalangeal bone to prevent movement of the flap. (B) Postoperative X-ray.

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  Fig. 4. Photograph at 7 weeks after the original operation showing reconstructed fingertip and preservation of full range of motion.

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