Clinical application of three kinds of anastomosis methods of digital artery in replantation of degloving amputated thumb and fingers of Urbaniak III type in children

Abstract

Objective To report the clinical application and efficacy of three kinds of anastomosis methods of digital artery in replantation of degloving amputated thumb and fingers in children. Methods From May 2012 to July 2018, 16 children with 17 fingers of degloving amputated injuries were replanted. According to Hou Ruixing's classification method of finger degloving injury type Ⅲ, the cases were classified intoⅠ degree of 6 fingers,Ⅱ degree of 11 fingers base on different skin avulsion planes. Three kinds of anastomosis methods of digital artery were in situ anastomosis of bilateral digital artery in 7 cases 8 fingers, cross anastomosis of a digital artery in 7 cases 7 fingers and transposition anastomosis of adjacent digital artery in 2 cases 2 fingers. Results The replantation of 17 fingers in 16 cases was successfully completed. The postoperative blood circulation was good. Among them, 7 cases 8 fingers with bilateral digital artery anastomosis survived, 3 cases 3 fingers with cross anastomosis of a digital artery occurred necrosis, and 2 cases 2 fingers with transposition anastomosis of digital artery survived. Thirteen patients with 14 fingers survived were follow-up for 3 to 36 months, with an average of 18 months. The growth of nails was found in all the fingers anastomosed with bilateral phalangeal arteries, including 2 cases of nail growth deformity, 1 case of partial absorption of the distal phalangeal bone leading to the shortening of the distal phalangeal body, while the function of pinching and the skin color and temperature were normal. The growth of nails was found in 4 surviving affected fingers with cross anastomosis of a digital artery, including 2 cases of nail growth deformity, 2 cases of partial absorption of the distal phalangeal bone leading to the shortening of the distal phalangeal body, which did not affect the holding function with slightly poor skin color, low temperature and finger body atrophy. The growth of nails was found in all the fingers with transposition anastomosis of digital artery, including 1 case of nail growth deformity. The finger was shorter and thicker than the healthy side. The flexion and extension of the finger were good. The skin color was normal and the skin temperature was slightly lower. According to the functional evaluation criteria of replantation of severed fingers issued by Hand Surgery Society of Chinese Medical Association, the results were rated as excellent in 7 cases, good in 4 cases and poor in 2 cases. Conclusion For Urbaniak Ⅲ type amputated finger, replantation should be performed as long as the finger body is relatively intact, and the blood supply should be reconstructed by in situ anastomosis of bilateral digital arteries as far as possible. This method has high survival rate and good recovery of finger shape and function after replantation. Key words: Replantation; Treatment outcome; Child; Degloving injury