Foster replantation of fingertip using neighbouring digital artery in a young child

• Published in: Journal of plastic, reconstructive & aesthetic surgery reconstructive & aesthetic surgery, 2010-06, Vol.63 (6), p.e532-e534
• Main Authors: Xu, Jing-hong, Gao, Zheng-jun, Yao, Jing-ming, Tan, Wei-qiang, Dawreeawo, Javed
• Format: Article
• Language: English
• Subjects: Age Factors; Amputated fingertip; Amputation, Traumatic - pathology; Amputation, Traumatic - surgery; Anastomosis, Surgical; Child, Preschool; Female; Finger Injuries - pathology; Finger Injuries - surgery; Foster replantation; Humans; Microsurgery; Neighbouring digital artery; Plastic Surgery; Radial Artery - surgery; Replantation - methods; Ulnar Artery - surgery
• ISSN: 1748-6815; 1878-0539
• DOI: 10.1016/j.bjps.2009.11.025

Summary Reconstruction of an amputated fingertip in a young child demands special techniques for success. We report a 2.5-year-old female patient with an amputated left index fingertip with the vascular defect being too severe to perform the usual replantation. Comparing several methods, we used the neighbouring digital artery as the feeding artery to perform foster replantation. Finally, the patient was satisfied with the appearance and function of her fingers. The clinical case, techniques, results are described and discussed. We consider it a useful technique, especially for those with a rather severe vascular defect. Patient A 2.5-year-old girl suffered a crush amputation of the left index fingertip. Only the flexor tendon of the amputated fingertip was connected to the proximal finger tissue and the blood supply was completely lost ( Figure 1 ). Methods The distal amputated fingertip was fixed using Kirschner wire under general anaesthesia. Then, microsurgery operation was carried out immediately to replant this amputated fingertip. Both ulnar and radial digital arteries were avulsed, while the dorsal vein was intact and the digital nerve was also surviving. The integrity of blood vessels was too traumatised to connect to the proximal part. In the case of the distal part of the ulnar artery of the injured index finger, the blood supply was established by anastomosing the distal end of the amputated tip and the radial artery of the middle finger, which was the feeding artery ( Figure 2 ). A 11/0 nylon suture was used. The dorsal vein and digital nerve were repaired by means of microsurgical anastomosis. The wound was covered with the dorsal skin of the middle finger and the palmar skin of the index finger to form a skin pedicle, and then, immobility of the two fingers was maintained to prevent avulsion. Result The index tip obtained good blood supply and survived completely ( Figure 3 ). Detachment of the index and middle finger was performed after 3 weeks, and both of the fingers showed good blood supply ( Figure 4 ). The appearance and function of the index and middle fingers were satisfactory 3 months postoperatively.