Department of Plastic surgery, First Affiliated Hospital, College of Medicine, ZheJiang University, 79# QingChun Road, HangZhou, ZheJing Province, PR China 310003 2.
J Plast Reconstr Aesthet Surg. 2010 Jun;63(6):e532-4. doi: 10.1016/j.bjps.2009.11.025. Epub 2009 Dec 28.
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.
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).
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.
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.
小儿断指再植要求特殊技术才能成功。我们报告了一例 2.5 岁女性患儿左示指尖离断，血管缺损严重，无法进行常规再植。通过比较几种方法，我们采用邻指指动脉作为供血动脉进行寄养再植。最终，患者对其手指的外观和功能均满意。本文描述并讨论了该病例、手术技术和结果。我们认为该方法对于血管缺损较严重的患者尤其有用。
2.5 岁女孩，因挤压伤致左示指尖完全离断，仅断指近节指腹有屈肌腱相连，血供完全丧失（图 1）。
在全身麻醉下用克氏针固定断指残端，然后立即进行显微镜下手术再植。尺、桡侧指动脉均撕脱，背侧静脉完整，指神经存活。近节断端血管完整性受损严重，无法与近端吻合。示指指固有动脉尺侧断端，通过吻合离断指端与中指桡侧动脉建立血供，作为供血动脉（图 2）。使用 11/0 尼龙缝线吻合。采用显微镜下吻合修复背侧静脉和指神经。中、示指背侧皮肤和掌侧皮肤覆盖创面形成皮瓣，固定两指以防止撕脱。
示指尖获得良好血供，完全存活（图 3）。3 周后行示指、中指分离，两指血供良好（图 4）。术后 3 个月，示指、中指外观和功能均满意。
