Abstract
Three cases of fingertip amputation at the level between the distal phalanx and the nail base in children below 2 years of age were treated by replantation or revascularization. The injury was complete in two, and incomplete in one. All three fingerstips survived with artery anastomosis without the need for a blood transfusion. In two venous anastomosis failed and venous drainage was achieved by 3-hourly pinprick. Survival of an amputated finger can be expected in cases where venous reconstruction is not possible, provided that there is adequate venous drainage.
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References
1.
Al-Qattan
MM
Zuker
RM
. The use of a styrofoam cup in leeching replanted digits . Br J Plast Surg , 1993 , 46 : 621 –621 .
2.
Baker
GL
Kleinert
JM
. Digit replantation in infants and young children: Determinants of survival . Plast Reconstr Surg , 1994 , 94 : 139 –45 .
3.
Cheng
GL
Pan
DD
Yang
ZX
Fang
GR
Gong
XS
. Digital replantation in children . Ann Plast Surg , 1985 , 15 : 325 –31 .
4.
Faivre
S
Lim
A
Dautel
G
Duteille
F
Merle
M
. Adjacent and spontaneous neurotization after distal digital replantation in children . Plast Reconstr Surg , 2003 , 111 : 159 –65 .
5.
Gaul
JS
3rd
Nunley
JA
. Microvascular replantation in a seven-month-old girl: A case report . Microsurgery , 1988 , 9 : 204 –7 .
6.
Gordon
L
Leitner
DW
Buncke
HJ
Alpert
BS
. Partial nail plate removal after digital replantation as an alternative method of venous drainage . J Hand Surg Am , 1985 , 10 : 360 –4 .
7.
Hahn
HO
Jung
SG
. Results of replantation of amputated fingertips in 450 patients . J Reconstr Microsurg , 2006 , 22 : 407 –13 .
8.
Han
SK
Lee
BI
Kim
WK
. Topical and systemic anticoagulation in the treatment of absent or compromised venous outflow in replanted fingertips . J Hand Surg Am , 2000 , 25 : 659 –67 .
9.
Hasuo
T
Nishi
G
Tsuchiya
D
Otsuka
T
. Fingertip replantations: Importance of venous anastomosis and the clinical results . Hand Surg , 2009 , 14 : 1 –6 .
10.
Hirase
Y
. Salvage of fingertip amputated at nail level: New surgical principles and treatments . Ann Plast Surg , 1997 , 38 : 151 –7 .
11.
Ishikawa
K
Ogawa
Y
Soeda
H
. A new classification of the amputation level for the distal part of the finger . J Jpn SRM , 1990 , 3 : 54 –6 .
12.
Ito
H
Sasaki
K
Morioka
K
Nozaki
M
. Fingertip amputation salvage on arterial anastomosis alone: An investigation of its limitations . Ann Plast Surg , 2010 , 65 : 302 –5 .
13.
Kamei
K
Sinokawa
Y
Kishibe
M
. The venocutaneous fistula: A new technique for reducing venous congestion in replanted fingertips . Plast Reconstr Surg , 1997 , 99 : 1771 –4 .
14.
Kim
WK
Lim
JH
Han
SK
. Fingertip replantations: Clinical evaluation of 135 digits . Plast Reconstr Surg , 1996 , 98 : 470 –6 .
15.
Koshima
I
Soeda
S
Moriguchi
T
Higaki
H
Miyakawa
S
Yamasaki
M
. The use of arteriovenous anastomosis for replantation of the distal phalanx of the fingers . Plast Reconstr Surg , 1992 , 89 : 710 –14 .
16.
Koshima
I
Yamashita
S
Sugiyama
N
Ushio
S
Tsutsui
T
Nanba
Y
. Successful delayed venous drainage in 16 consecutive distal phalangeal replantations . Plast Reconstr Surg , 2005 , 115 : 149 –54 .
17.
Kubo
T
Ikita
Y
Watari
S
Okuhira
N
Tsuge
K
. The smallest digital replant yet?
Br J Plast Surg , 1976 , 29 : 313 –14 .
18.
Michalko
KB
Bentz
ML
. Digital replantation in children . Crit Care Med , 2002 , 30 : S444 –7 .
19.
Ozcelik
IB
Tuncer
S
Purisa
H
. Sensory outcome of fingertip replantations without nerve repair . Microsurgery , 2008 , 28 : 524 –30 .
20.
Shi
D
Qi
J
Li
D
Zhu
L
Jin
W
Cai
D
. Fingertip replantation at or beyond the nail base in children . Microsurgery , 2010 , 30 : 380 –5 .
21.
Yamano
Y
. Replantation of fingertips . J Hand Surg Br , 1993 , 18 : 157 –62 .
22.
Yildirim
S
Calikapan
GT
Akoz
T
. Reconstructive microsurgery in pediatric population – a series of 25 patients . Microsurgery , 2008 , 28 : 99 –107 .