Double Opposing Stiletto (DOS) Flaps For Pediatric Finger Contracture

PURPOSE: A variety of congenital and traumatic causes of contractures of the hand in the pediatric population can cause extensive issues that restrict growth, decrease function and compromise aesthetics. We discuss eight such cases of pediatric contractures resulting from treadmill-related burns, camptodactyly and arthrogryposis. We describe a novel technique that restores function, improves aesthetics, and has several advantages as compared to traditional surgical intervention options deemed gold-standard for hand contractures today. The stiletto flap is a technique often utilized to increase coverage for areas of low tissue availability, such as in a burn-contracture release. Our novel double opposing stiletto (DOS) flaps approach has been demonstrated in the treatment of eight cases of pediatric hand contractures to restore function. METHODS: All patient information was acquired from electronic medical records and informed consent was acquired from legal guardians. For all cases, with the finger in full extension, two opposing stiletto flaps were designed over the anticipated defect. Underlying flexor tendons and neurovascular bundles were protected bilaterally. The scar was fully released from subcutaneous tissue and the finger was placed in full extension. The two opposing stiletto flaps were transposed to cover the defect and sutured into place. The finger had no circumferential tightness and could be passively placed in full extension to neutral with the defect fully covered, thus not requiring full thickness skin grafting (FTSG). Kirscher wire was applied as deemed necessary. RESULTS: All patients demonstrated appropriate recovery and healing with full range of motion of the affected fingers. Patients deny pain, can lay their hands flat, and show no recurrent contractures at follow-up. They were able to fully extend the affected fingers and had well-healed, minimally visible scars. All flaps were viable and patients were followed for up to 1 year post-operatively, with consented photographs analyzed using Image J software to qualitatively and quantitatively measure improvement in angle of contracture. CONCLUSION: The DOS flap is a novel local flap design demonstrated here in the reconstruction of hand contractures in eight pediatric patients. The DOS flap technique allows surgeons to not rely on needing a FTSG, reducing the need for multiple surgical interventions, exposure to general anesthesia, and potential graft failure. We present this novel and innovative technique as a reliable option for treating such cases of contractures. *Source: https://ps-rc.org/meeting/Program/2026/EP135.cgi*