WOFAPS 2025 8th World Congress of Pediatric Surgery

Shi Gao

Chlidren's Hospital Zhe Jiang University School of Medicine

Objective To evaluate the outcomes of finger replantation in infant patients by analyzing the clinical management and prognosis.

Methods A retrospective study was conducted on infant patients with finger amputations treated at Children’s Hospital, Zhejiang University School of Medicine (ZUCH) between January 2023 and January 2025. All patients underwent microsurgical replantation, with K-wire fixation used for fractures. For Types I, II and III of Ishikawa, anastomosis was performed on arterial and nerve structures, while for Type IV of Ishikawa, in addition to artery and nerve repair, venous and tendon repairs were carried out, depending on injury severity. In cases where the vein was non-repairable, distal bleeding and continuous heparinized saline irrigation were performed as an alternative. For proximal phalanx amputations cases, after bone debridement and fixation, flexor and extensor tendons, digital arteries, nerves, and dorsal veins were sequentially anastomosed. Postoperative management included warming, anticoagulation, anti-infection, and antispasmodic treatments.

Results A total of 11 cases were included in this study, involving eight male and three female patients, aged 8 months to three years, with a mean age of 1 years and 10 months. Of these, 9 involved distal amputations, including 6 fingertip amputations. Based on the Ishikawa classification, there were 2 cases of Type I, 4 cases of Type II, 2 cases of Type III, and 1 case of Type IV amputation. All patients were followed up for 6-8 months. There were 9 cases achieved complete survival, while 2 cases developed partial necrosis due to vascular crisis, resulting in a complete survival rate of 81.8%. Functional outcomes, assessed according to the Chinese Medical Association Hand Surgery Branch’s replantation criteria, revealed 7 cases with excellent results and 4 with good results.

Conclusion Distal finger amputations, particularly fingertip amputations, are common in infant patients, and replantation should be considered when feasible. This procedure demands advanced microsurgical skills, and the post-replantation survival rate is favorable. The prognosis are heavily dependent on meticulous postoperative management.