Abstract
Introduction The amputation of the thumb or any other finger in children has the absolute indication of replantation in order to avoid the psychological trauma suffered by the child - the future adolescent and young adult. Functional results, sensitivity and aesthetic outcomes are better than in adults. The younger the patient, the more difficult reconstructive techniques of bone, tendon and soft tissue repair, vascular or nerve micro-anastomosis, postoperative care are. The very good outcome, fast social reintegration and satisfaction of the parents, deserves all the needed effort. Material and methods The study is based on 5 cases of digital amputation in children (4 boys and 1 girl) aged between 3 and 4 years and 6 months old. In 2 cases, the amputation was at the first phalanx of the index. In other 2 cases, the amputation was at the second phalanx of the middle finger and in the fifth case, at the second phalanx of the fourth finger. The trauma occurred during housekeeping activities such as wood cutting using an ax. Bone repair was difficult due (with needle) to the need of keeping the growth cartilage intact. The small vessel diameter constrained us to use 11-0 suture thread and a reduced number of stitches. Postoperative analgesia played an important role in preventing vasospasm and increased the chance of a successful replantation. The splinting was done taking into account the principles of immobilization in children. The 4 year old child developed a postoperative venous insufficiency that we managed successfully. In one case, a secondary surgical intervention was necessary for the extensor apparatus reconstruction. Discussions In order to evaluate the outcomes, we used for sensibility the Weber and Semmes-Weinstein tests. According to Nakamura Tamai criteria, the outcomes were excellent in all cases. Conclusions Replantation of the amputated finger in children has an absolute indication. The younger the patient the more difficult the surgical repair is, but is counterbalanced by the good functional and aesthetic results.
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