Kelley Naomi H, Shaver Tori L, Morrell Nathan T
Orthopedics Hand Surgery, University of New Mexico Health Sciences Center, Albuquerque, USA.
Cureus. 2024 Apr 23;16(4):e58856. doi: 10.7759/cureus.58856. eCollection 2024 Apr.
Finger amputations in children present unique challenges and require special considerations compared to their adult counterparts. Maximizing length and preserving fingertip bulk and sensation is essential for maintaining a functional digit. Synthetic dermal substitutes have been recently used for soft tissue coverage for pediatric syndactyly as well as burn injuries; however, the literature discussing pediatric amputation cases with soft tissue damage proximal to the bony level is limited.In this case, we report a two-year-old patient who developed dry gangrene of her right index finger after multiple rabbit bites and underwent an amputation through the distal interphalangeal joint. Circumferential soft-tissue debridement proximal to the tip of the middle phalanx was required, leaving substantial exposed bone with no soft tissue envelope. We report our experience of single-stage stacking Integra dermal substitute directly onto the exposed bone to provide both finger bulk and soft tissue coverage.The patient displayed no functional limitations three years post-surgery.For instances when local or distant flap coverage may not be feasible, we present a novel technique to reconstruct, provide bulk, and preserve length in pediatric finger amputations. This case highlights that the utility of dermal substitutes is expanding and are providing more technical options.
与成人相比，儿童手指截肢面临独特的挑战，需要特殊考虑。最大限度地延长手指长度并保留指尖体积和感觉对于维持手指功能至关重要。合成真皮替代物最近已用于小儿并指以及烧伤的软组织覆盖；然而，讨论骨水平近端有软组织损伤的小儿截肢病例的文献有限。在本病例中，我们报告了一名两岁患者，其右手食指在多次被兔子咬伤后发生干性坏疽，并通过远侧指间关节进行了截肢。需要在中节指骨尖端近端进行环形软组织清创，导致大量骨质外露且无软组织包膜。我们报告了我们将Integra真皮替代物单阶段直接堆叠在裸露骨头上以提供手指体积和软组织覆盖的经验。术后三年，患者未表现出功能受限。对于局部或远处皮瓣覆盖可能不可行 的情况 ，我们提出了一种在小儿手指截肢术中进行重建、增加体积并保留长度的新技术。本病例突出了真皮替代物的应用正在扩大，并提供了更多技术选择。
