Supermicrosurgical Technique for Distal Digital Amputation Replantation in Children Under 3 Years Old: A...

Objective: Vascular anastomosis is technically challenging in young children due to their slender and delicate vessels, which causes the clinical treatment of distal digital amputation to be relatively difficult. This study aims to investigate the therapeutic efficacy of the supermicrosurgical technique in the replantation of distal digital amputation in children under 3 years old. Methods: A retrospective analysis was conducted on 13 children (13 digits) with distal digital amputation from January 2023 to January 2026. All children underwent distal digital replantation using the supermicrosurgical technique. Fingertip bloodletting therapy was applied depending on the availability of anastomotic veins. Postoperatively, all children received symptomatic and supportive treatments, including anticoagulation, anti-infection, and antispasmodic therapy. Follow-up evaluations included finger growth, appearance, nail growth, and sensory and motor function. Parental satisfaction was assessed using the Michigan Hand Outcomes Questionnaire (MHQ). Results: There were nine males and four females, aged 8.7-36 months. Causes of injuries included six cases of door crush, two of heavy object crush and five of machine-related trauma. The warm ischemia time of the amputated digits was 4.6-11.8 h (mean time: 6.8 h). According to the Modified Ishikawa Classification, there were four Type I, four Type II, two Type III, and three Type IV injuries. All children received successful replantation surgery using the supermicrosurgical technique and were followed up for 6 to 12 months. Complete survival of the replanted digits was achieved in 11 cases. Two cases developed necrosis secondary to arterial crisis, giving an overall complete survival rate of 84.6%. The survived replanted digits exhibited almost normal appearance, good vascular perfusion, intact nail beds, restored sensation, and satisfactory flexion and extension. The necrotic digits showed pulp atrophy and hook nail deformity. According to the MHQ, all parents were satisfied with the clinical outcomes. Conclusions: Distal digital amputation, especially fingertip amputation, is commonly encountered in children under 3 years old, and replantation should be performed. High-quality anastomosis of tiny blood vessels under the supermicrosurgical technique, combined with rigorous postoperative management, contributes to a high survival rate and better clinical outcomes in children under 3 years old with distal digital replantation.