Replantation of Severed Fingers in Children

Abstract

The technology of the replantation of severed fingers makes it possible to achieve normal limb morphology and functional recovery through precise microvascular anastomosis, and sufficient repair of bone, tendons, the skin, and nerves. In 1964, Malt and McKhann reported that they preserved a 12-year-old boy’s upper arm in May 1962. In 1963, Kleinert et al. (1963) first reconstructed the blood supply of the thumb by means of arterial anastomosis. In 1965, Komatsu and Tamai (1968) successfully completed the replantation of the first complete amputation of a finger. In 1974, Tamai performed a successful replantation of the left proximal interphalangeal joint of a little finger that had been completely cut off in a 20-month-old child. At that time, Tamai anastomosed the finger artery and finger nerve with the help of a microscope and obtained good clinical results. In 1980, Cheng Guoliang et al. (1998) reported a case of a 45-month-old child in whom 2–5 fingers on the left hand had been completely cut off. All the fingers survived after replantation. In 1980, Wang Chengqi et al. reported a successful case of a 25-month-old child with 2–5 fingers completely severed from the left hand, in which the index and middle fingers were shifted with the middle and ring fingers. In 1982, Cheng Guoliang et al. (1982) reported a 9- to 15-year follow-up study of 26 cases with 45 replanted fingers and found that the postoperative excellent and good rate was 100%. This study truthfully reflected the level of severed finger replantation in children in our country, which has leapt up to the world’s advanced level in a short period of time. However, compared with adults, replantation of severed fingers in children still has its peculiarities:

• 1. The finger blood vessel is small and anastomosis is very difficult.

• 2. Children’s mental development is not complete; thus, they cannot fully cooperate with the treatment after the operation.

• 3. Limitations of drug use

  The development of the surgical microscope, fine microsurgical instruments, and microsuture hardware laid the foundations for the replantation of severed fingers in children up to the 1970s.