gms | German Medical Science

Objectives/Interrogation: Pediatric fingertip replantation is a challenge microsurgery for finger replantation. Reported results at a long time (under 10 years) follow-up of children digital replantation consistently show surprised good sensation, poor cosmetic, and satisfaction with good growth rate with good blood circulation. We hypothesized that children fingertip replantation would provide a high level of satisfaction and function at a minimum of 10 years.

Methods: Twenty-five digits in 20 patients, including 3 infants, underwent fingertip replantation for traumatic injury at an average age of 7 years. Patients returned for radiographic and clinical evaluation, and the cosmetic evaluation (pulp atrophy& nailbed deformity) and sensory function (2PD test) were used. Follow-up was a minimum of 10 years (average, 15 years).

Results and Conclusions: Nineteen digits (80%) underwent no further surgery at a minimum 10-year follow-up. The average time to undergo additional procedures to improve function, was 0.4 procedures. Fifteen of 20 patients who continued to be satisfied, with minimal pulp atrophy and minimal decrease in pulp sensation compared the contralateral digits. Average 2PD test was 6.8mm. The nailbed deformity was six digits, and severe pulp atrophy was three digits. The DIP joints flexion-extension arc was 35 degrees, and pinch strength was 87% of the contralateral side. All patients returned to their original life. There was significant correlation between good fingertip blood circulation and satisfaction level. The additional procedure revealed high risk of growth plate injury and epidermis injury in patients who underwent fingertip replantation.

Pediatric fingertip replantation provides satisfaction at a minimum of 10 years. Whereas we recommend no severe growth plate and nail epidermis injury for fingertip replantation, crushed and avulsion injury should not be excluded as children fingertip replantation candidates; these patients should undergo appropriate preoperative counseling of their fingertip replantation and the increased additional procedures after replantation.