[Finger tip amputations in children].

Among the various alternative forms of treatment of digital tip amputations, replantation of the amputated tip as composite graft or conservative treatment (healing by secondary intention) are of special interest for the management of fingertip injuries in children. From 1986 until 1987, the authors treated thirteen fingertip amputations in children between one and eight years of age (mean 3.5 years). In twelve cases, the amputated tip was reattached as composite graft, one injury healed by secondary intention. Twelve children were reexamined according to a prospective protocol after a mean follow-up time of 3.4 years. In three cases, primary healing of the replanted tip could be observed, in eight cases partial necrosis and superficial mummification preceded complete healing. At follow-up, seven cases presented with an anatomical tip, four with a slight asymmetry. Distal phalangeal length was identical to the opposite side, but in two cases a maximal loss of length of 2 mm was observed. Fingernails showed no significant deformities, although nail bed injuries had occurred in 90% of the cases. Sensitivity was normal in all cases. Child and parents considered the final result excellent in 75% and good in 25%. Reattachment as composite graft or conservative treatment for management of fingertip amputations in children (Zone I to III according to Rosenthal) is recommended and discussed.