Background: Pediatric finger amputations pose unique technical challenges due to diminutive vessel diameters ranging from 0.3 to 1.5 mm, depending on age. Despite the significant functional impact of digit loss in the growing hand, there is limited literature describing outcomes in the pediatric population, and no consistent pharmacological treatment guidelines exist.
Methods: A retrospective electronic medical record review was conducted of patients aged 18 years or under who sustained finger amputations and underwent surgical treatment at our institution from January 2013 to December 2023. Data collected included patient demographics, injured digit, mechanism of injury, surgical method (replantation/arteriorrhaphy, composite graft, or toe pulp graft), pharmacological treatment, length of admission, treatment duration (time to dressing removal), and complications, including necrosis and infection.
Results: 29 patients were included, with a mean age of 8.58 years (range 13 months to 18 years); 25 male and 4 female. The most common mechanism was crushing injury (n=25), predominantly door-related (n=12). Replantation or arteriorrhaphy was performed in 14 patients, composite graft in 10, and toe pulp graft in 3. Mean admission duration was 13.7 days for replantation/arteriorrhaphy, 8 days for composite graft, and 10.6 days for toe pulp graft. Complications in the replantation group included partial necrosis requiring secondary healing (n=4), partial necrosis requiring regrafting (n=1), total necrosis requiring stump revision (n=1), and infection (n=1). No major complications were observed in the composite graft or toe pulp graft groups.
Conclusion: Replantation or arteriorrhaphy should be attempted in pediatric finger amputations, given the potential for substantial functional deficit, despite technical difficulty. Pharmacological adjuncts, including prostaglandin E1, aspirin, and heparin, were utilized variably across cases, reflecting the absence of a standardized protocol. This study highlights the need for prospective multicenter research to establish evidence-based pharmacological guidelines in this population.