gms | German Medical Science

Objectives/Interrogation: The reconstruction of fingertip amputations 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 allows to preserve otherwise irreplaceable structures, such as the nail bed and the hyponychium, enabling children to maintain an anatomically and functionally normal fingertip. We present a series of three pediatric patients treated with this proposed method, which combines composite autograft and semi-occlusive dressing (CASOD technique).

Methods: Patients were admitted to the operating room. Under anesthesia, surgical irrigation and debridement, with excision of part of the adipose tissue of the fingertip was performed, followed by suture of the amputated segment. In cases of bone involvement, a hypodermic needle was placed as fixation method. A semi-occlusive wound dressing (Tegaderm ®) was placed for 6 weeks. Patients were evaluated weekly to insure the dressing maintained its sealing properties.

Results and Conclusions: 3 patients were included in this study, with ages between 18 months-10 years. The amputation level, according to the modified Ishikawa classification was 1a (1 patient) and 1b (2 patients). Patients were followed-up for 13 months. In all three cases, de fingertip was preserved without necrosis or any other complication. The anatomy and aesthetic aspect of the fingertip was maintained.

This technique - "CASOD" - provides a new, simple and reproducible approach that offers good results. For this technique, preserving the wound's inflammatory exudate is fundamental, since it supplies the environmental conditions for regeneration without scar tissue formation. A wider number of patients needs to be recruited to this study in order to validate the technique.