BACKGROUND: Injuries of distal phalanges are the most common type of hand trauma in children. The problem of coverage of soft tissue defects of distal phalanges remains. Many methods of coverage of distal phalanges defects have been developed. There is no generally accepted approach or an algorithm in treatment of adults and children with such type of trauma. AIM: This study aimed to reveal the most universal method of coverage of distal phalanges defects in children using various reconstruction methods that are used at the Department of Reconstructive Microsurgery of Filatov State Children Hospital. MATERIALS AND METHODS: From 2019 to 2020, 70 children with defects of distal phalanges were treated. The coverage of defects was performed by using a flap (n = 23), cross-finger flap (n = 5), V-Y advancement flap (n = 28), reverse-flow homodigital island flap (n = 11), and full-thickness skin graft (n = 3). Results of the defect coverage were evaluated by objective (difference between the lengths of the operated and contralateral phalanges, two-point discrimination test, presence/absence of stiffness in the distal interphalangeal joint) and subjective (definition of cold intolerance, Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire) criteria. RESULTS: The largest difference between the lengths of the operated and contralateral phalanges was obtained in V-Y plasty. The two-point discrimination sensitivity was the highest in V-Y plasty and a little less with island flap. Cold intolerance was the most common complication of homodigital island flap. Results of the DASH survey was the best in the homodigital island flap and full-thickness skin graft. CONCLUSION: Based on the analysis of the experience of surgeries to close soft tissue defects of the nail phalanges, the best results were obtained with reverse-flow homodigital island, which is considered as the most versatile and reliable approach.

BACKGROUND: The hand has always been a highly organized tool in humans daily and professional activity. Distal phalanges are most commonly exposed to trauma, which often cause defects that need to be covered through plastic surgery. One of the most reliable and universal methods for fingertip reconstruction is the reverse-flow homodigital island flap. CLINICAL CASES: This series of clinical cases describe three children aged 7, 8, and 11 years who underwent coverage of fingertip defects with the reverse-flow homodigital island flap. In all cases, mechanisms of injury were associated with crushing and rupture of soft tissues. All children underwent coverage of fingertip defects with the reverse-flow homodigital island flap. In the first case, evaluation results at 6 months after surgery revealed 4 mm in the Webers test and phalanx length deficit of 2 mm. In the second case, the assessment performed 1 month after surgery revealed 5 mm in the Webers test and the length of the operated phalanx corresponds to the contralateral one. In the third case, results of the 2-month observation period revealed 4 mm in the Webers test and lengths of the operated and contralateral phalanges were the same. DISCUSSION: The reverse-flow homodigital island flaps have irrefragable advantages among methods of surgical reconstruction of soft tissues of distal phalanges. These are single-stage reconstruction techniques that can possibly replenish sufficient amounts of soft tissues to the defect. A literature data analysis of the outcomes of the fingertip reconstruction through the reverse-flow homodigital island flaps revealed good and satisfactory results. CONCLUSIONS: The method of the reverse-flow homodigital island flap has potential to take a significant place in pediatric traumatology and reconstructive surgery.

The authors propose a new type of classification of various anatomical variants of venous return from the right half of the colon based on the application of the principles of topology and combinatorics. The article presents data obtained from the topographic and anatomical study of the venous return from the right hemicolon collected from anatomical material (25 observations), and describes the coding algorithm in each case, allocating it to a particular class according to the proposed classification. A block diagram of a software package for semi-automatic retopology of venous return from the right half of the colon is also proposed.