The clinical features and replantation strategies of Crushed amputations at the distal fingers in children

Objective To investigate the clinical features of crushed amputations at the distal fingers in children, summarize strategies for handling the vessels in replantation and assess its clinical outcomes. Methods From January 2005 to August 2009, 38 severed fingers in 28 patients of 11 months to 11.5 years old were replanted. The vessels were anastomosed under 12X to 15X magnification based on the vascular characteristics according to Ishikawa's classification. Results Tirty-five out of the 38 replanted fingers survived, while only 3 necrosed. The survival rate was 92.1%. Postoperative follow-up ranged from 3 months to 3 years. Satisfactory results in terms of the contours of finger nail and pulp, and finger length were achieved in all the survived cases except for mild lateral deviation deformity in three cases due to the crushing injury of epiphysis in zone Ⅳ. According to the functional evaluation criteria formulated by Chinese Hand Surgery Society, results were excellent in 18 cases, good in 14 cases, and poor in 3 cases. The overall excellent-good rate was 91.4%. Conclusion Blunt injury is the common cause of distal finger amputation in children, mostly manifested as crushed amputations. Satisfactory results can be obtained provided that the surgeon is familiar with the vascular anatomy of the distal finger, and that meticulous debridement and precise vascular anastomosis are done. Therefore, the crushed amputations at the distal fingers in children are also the candidates for replantation and should be replanted aggressively. Key words: Microsurgery;  Replantation;  Child