Reconstruction of Distal Finger Amputations in Children with Composite Autograft and Semi-Oclusive Dressing

Abstract

The reconstruction of finger tip amputation in children is challenging. There are many procedures described to treat this injury, none of which present optimal results. Repositioning of the amputated segment as an autograft or with microsurgical techniques seems to offer the best outcome. It enables the preservation of otherwise irreplaceable structures, such as the nail bed and the hyponychium, thus enabling children to mantain an anatomically and functionally normal finger pulp. We present a series of three pediatric patients treated with a new technique, which combines composite autograft and semi-oclusive dressing (CASOD). The results observed so far have been promising.

Keywords

Finger tip amputation - children - reconstruction

Publication History

Received: 27 July 2020

Accepted: 02 June 2020

Article published online:
30 September 2021

• Bibliografía

• 1 Hoigné D, Hug U, Schürch M, Meoli M, von Wartburg U. Semi-occlusive dressing for the treatment of fingertip amputations with exposed bone: quantity and quality of soft-tissue regeneration. J Hand Surg Eur Vol 2014; 39 (05) 505-509
• 2 Adani R, Marcoccio I, Tarallo L. Treatment of fingertips amputation using the Hirase technique. Hand Surg 2003; 8 (02) 257-264
• 3 Johnson D, Giele H. Restoration of the nail apparatus following fingertip amputation by perionychial grafts supported by local flaps, in children and adults. J Plast Reconstr Aesthet Surg 2011; 64 (06) 776-781
• 4 Hsu CC, Lin YT, Moran SL, Lin CH, Wei FC, Lin CH. Arterial and venous revascularization with bifurcation of a single central artery: a reliable strategy for Tamai Zone I replantation. Plast Reconstr Surg 2010; 126 (06) 2043-2051
• 5 Butler DP, Murugesan L, Ruston J, Woollard AC, Jemec B. The outcomes of digital tip amputation replacement as a composite graft in a paediatric population. J Hand Surg Eur Vol 2016; 41 (02) 164-170
• 6 Ishikawa K, Ogawa Y, Soeda H, Yoshida Y. A new classification of the amputation levelfor the distal part of the finger. J Jpn Soc Microsurg 1990; 3: 54-62
• 7 Imaizumi A, Ishida K, Arashiro K, Nishizeki O. Validity of exploration for suitable vessels for replantation in the distal fingertip amputation in early childhood: replantation or composite graft. J Plast Surg Hand Surg 2013; 47 (04) 258-262
• 8 Wen G, Xu J, Chai YM. Fingertip replantation with palmar venous anatomoses in children. Ann Plast Surg 2017; 78 (06) 692-696
• 9 Goitz RJ, Westkaemper JG, Tomaino MM, Sotereanos DG. Soft-tissue defects of the digits. Coverage considerations. Hand Clin 1997; 13 (02) 189-205
• 10 Martin C, González del Pino J. Controversies in the treatment of fingertip amputations. Conservative versus surgical reconstruction. Clin Orthop Relat Res 1998; (353) 63-73
• 11 Roshan A, Grant I. Lessons for adult fingertip regeneration: glimpses from basic research. J Hand Surg Am 2012; 37 (06) 1287-1290
• 12 Choi Y, Cox C, Lally K, Li Y. The strategy and method in modulating finger regeneration. Regen Med 2014; 9 (02) 231-242
• 13 Mennen U, Wiese A. Fingertip injuries management with semi-occlusive dressing. J Hand Surg [Br] 1993; 18 (04) 416-422
• 14 Williams LR, Longo FM, Powell HC, Lundborg G, Varon S. Spatial-temporal progress of peripheral nerve regeneration within a silicone chamber: parameters for a bioassay. J Comp Neurol 1983; 218 (04) 460-470
• 15 Gil J, Garrido R, Gil R, Melgosa M. Materiales para la reparación y sustitución ósea. Factores de crecimiento y terapia genética en Cirugía Ortopédica y Traumatología. Mapfre Medicina 2003; 14: 51-65
• 16 Calvo R, Figueroa D, Díaz-Ledezma C, Vaisman A, Figueroa F. Aloinjertos óseos y la función del banco de huesos. Rev Med Chil 2011; 139 (05) 660-666