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Treatment of Pediatric Fingertip Amputations by Chest and Palm Subcutaneous Pocket Techniques
Koichiro Yanai1,2, Yuta Izawa1, Takafumi Suzuki1
1From the Department of Trauma Center, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan.
Insights
Chest and palm subcutaneous pocket techniques show promise for pediatric fingertip amputations. Optimizing the pocketing period and postoperative care can improve graft survival in young children.
Area of Science:
- Pediatric surgery
- Reconstructive surgery
- Microsurgery
Background:
- Fingertip amputations are rare in children under 2 years old.
- Chest and palm subcutaneous pocket techniques are effective but understudied.
- This study evaluates treatment outcomes and graft survival factors.
Purpose of the Study:
- To report treatment outcomes of pediatric fingertip amputations using chest and palm subcutaneous pocket techniques.
- To identify factors influencing graft survival in young children.
Main Methods:
- Retrospective review of pediatric patients (<2 years) with fingertip amputations.
- Data collected: age, amputation type, Ishikawa classification, donor site, pocketing period, postoperative care, graft survival.
- Graft survival assessed as complete recovery or partial necrosis.
Main Results:
- Six patients (7 digits) included; mean age 17.4 months.
- Five complete and 2 incomplete amputations; Ishikawa subzones I, II, and III represented.
- All digits survived, but 43% experienced partial necrosis. Longer pocketing periods correlated with complete recovery.
Conclusions:
- Chest and palm subcutaneous pocket techniques are viable for pediatric fingertip amputations.
- Adequate pocketing duration and appropriate postoperative wound management are crucial for enhancing graft survival.
Background:
Although chest and palm subcutaneous pocket techniques are effective for pediatric fingertip amputations, particularly in pediatric patients younger than 2 years of age, few studies exist due to the rarity of these injuries. We report the treatment outcomes at our institution and consider factors associated with graft survival.
Methods:
We reviewed pediatric patients younger than 2 years of age with fingertip amputations who underwent the chest and palm subcutaneous pocket techniques between 2013 and 2025. Collected data included age, completeness of amputation, Ishikawa classification, donor site and pocketing period, postoperative management after separation (wet or gauze dressing), and graft survival. Graft survival was classified as complete recovery or partial necrosis.
Results:
Six patients (7 digits) were included in the study. The mean age was 17.4 months. Five digits had complete amputations, and 2 had incomplete amputations. According to the Ishikawa classification, 1 digit was classified as subzone I, and 3 digits each were classified as subzones II and III. Donor sites included 5 digits on the chest and 2 on the palm. The mean pocketing period was 11.7 days. All digits survived; however, partial necrosis occurred in 3 digits (43%). The pocketing period was longer in the complete recovery group (13.5 versus 9.3 d), and the wet dressing method tended to be used more frequently.
Conclusions:
Chest and palm subcutaneous pocket techniques are useful for pediatric fingertip amputations; however, maintaining an adequate pocketing period and appropriate postoperative wound management may be beneficial for improving graft survival.
