gms | German Medical Science

Objectives/Interrogation: Fingertip amputation in toddlers or children of preschool age is frequent. Loss of more than half of the nail bed and exposure of bone asks for coverage and reconstruction of nail bed and length. In small children the reconstruction by microsurgical replantation is impossible. In adults Paavilainen et al described 2009 a successful reconstruction by refixation of the tip by composite graft and temporary dermo-dermal fusion of the deepithelized fingertip to the palm to improve blood supply temporarily. Encouraged by his results we wanted to check if this technique is efficient in the not cooperating young children too.

Methods: From 2000 to2018 we performed the dermo-dermal fusion in 28 children, 17 of them were in preschool age. The median age of was 5.3 years. In 22 cases the amputation level was in zone 2 and 6 in zone 3 of Rosenthal classification. The amputations were caused by squeezing and avulsion in 27 fingers and by a clean cut in 1 patient. Postoperative they were immobilized in a fist bandage pressing the tip into the palm and a forearm finger cast for 4 weeks.

Results and Conclusions: In 22 of 28 cases the fingertip refixation was successful and the major part of the pulp and nail length could be preserved. In 3 cases the children had torn their finger out of the palm in the first 10 days postop ahead of time. These 3 patients healed secondarily with a good result in 2 and a satisfying result with some shortening of the tip in 1 patient. In 3 patients the fingertip was lost due to necrosis and infection.

This technique is an option to preserve length of the distal phalanges and nail bed in comparison to the treatment with semi-occlusive dressings and local flaps. In the aftercare it is essential to protect the injured finger against pull out.