Gao Shi,Chen Haiqiong,Zhao Guoqiang.Therapeutic experience of super-microsurgical techniques in replanting pediatric distal digital amputation[J].Journal of Clinical Pediatric Surgery,,():651-655.[doi:10.3760/cma.j.cn101785-20251212-00112]
Therapeutic experience of super-microsurgical techniques in replanting pediatric distal digital amputation
- Keywords:
- Micromanipulation; Finger Phalanges; Surgical Procedures; Operative; Child
- Abstract:
- Objective To explore the clinical efficacy of super-microsurgical techniques for pediatric distal finger replantation. Methods This study retrospectively analyzed the clinical data of 14 children (14 fingers) with distal finger amputation who were admitted to the Children’s Hospital Affiliated to Zhejiang University School of Medicine from January 2023 to January 2025 and were under the age of 6. There were 9 boys and 5 girls with an average age of 3Y4M(8M22D-5Y10M).All cases involved distal finger amputation with 9 cases involving fingertip amputation.According to the Ishikawa classification,the clinical types were Ⅰ(n=4),Ⅱ(n=5),Ⅲ(n=3) and Ⅳ(n=2).The causes of injury included door compression injury (n=7),heavy object impact injury (n=3) and machine trauma (n=4).Average ischemic time of severed finger was 6.5(4.2-12.6) hour.Finger replantation was performed with super-microsurgical techniques,including simple arterial and nerve anastomosis and postoperative fingertip bloodletting (n=12).Two Ishikawa Ⅳ type children underwent additional anastomosis of dorsal vein of fingers.After surgery,symptomatic supportive measures included warmth retention,anticoagulation,anti-infection and antispasmodic therapy.Follow-up evaluations for 6-12 months were conducted for finger development,appearance,nail growth,sensory function,motor function and parental satisfaction.Results Among them,13 cases attained complete survival of severed fingers.One child of Ishikawa type I developed necrosis due to arterial crisis with a complete survival rate of 92.8%.The surviving severed finger had a full and rosy appearance,normal nail bed and sensation,decent flexion and extension activities.Necrotic fingers displayed insufficient fullness of fingertip and hooked nail deformities.According to the trial evaluation criteria for finger replantation function of Branch of Hand Surgery,Chinese Medical Association,12 fingers were rated as excellent and 1 finger good; According to the Michigan Hand Function Rating Scale,all family members were satisfied.Conclusions In children,distal amputation has been a major cause of severed fingers.Whenever conditions permit,active replantation should be attempted.Super-microsurgery may achieve precise suturing of small blood vessels and nerves for distal severed fingers.It is vital for improving the survival rate of replantation.In conjunctions with standardized postoperative management,satisfactory appearance and functional recovery may be achieved.Its clinical application value is great.
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Memo
收稿日期:2025-12-12。
基金项目:浙江省省委共建重点项目(WKJ—ZJ—26053)
通讯作者:赵国强,Email:6516021@zju.edu.cn