Nonoperative management of distal fingertip amputations in children

Success with the uncommonly recognized technique of nonoperative management of fingertip amputations in children has prompted presentation of four cases so treated in our institution. Previously, fingertips amputated distal to the distal interphalangeal joint have been observed to regenerate in children under 12 years of age.1,2 MATERIAL Our patients were 1, 2, 4, and 9 years old. They had injured the thumb, middle, index, and small fingers, respectively. The levels of amputation are seen in Fig 1. Three injuries transsected the distal bone. All cases were evaluated for extent of injury and chosen for nonoperative therapy (Fig 2). The wounds were cleansed with antiseptic solution and dressed with fine mesh absorbent gauze impregnated with bismuth tribromophenate 3% in petrolatum blend (Xeroform) and sterile gauze bandage. To encourage mobility, no splints were used. Dressings were changed one week after injury and bi-weekly thereafter. All children were free of pain within 24 hours after treatment. Healing began at three weeks and was completed 12 weeks after injury. Good cosmetic and functional result with regeneration of the fingertip including nail was observed in each case (Fig 3). DISCUSSION Douglas1 and Illingworth2 were among the early proponents of the nonsurgical management of children9s fingertip injuries. Despite their well-documented success with this treatment, it is not widely practiced. Many3-5 continue to advocate reimplantation of the amputated tip, suture closure, or skin graft and flap application to the amputated stump. However, these techniques should be reserved for injuries to the proximal two phalanges or for disarticulation injuries where regeneration is not seen.