PDF(Pubmed)
Abstract：
Finger amputations in children present unique challenges and require special considerations compared to their adult counterparts. Maximizing length and preserving fingertip bulk and sensation is essential for maintaining a functional digit. Synthetic dermal substitutes have been recently used for soft tissue coverage for pediatric syndactyly as well as burn injuries; however, the literature discussing pediatric amputation cases with soft tissue damage proximal to the bony level is limited.In this case, we report a two-year-old patient who developed dry gangrene of her right index finger after multiple rabbit bites and underwent an amputation through the distal interphalangeal joint. Circumferential soft-tissue debridement proximal to the tip of the middle phalanx was required, leaving substantial exposed bone with no soft tissue envelope. We report our experience of single-stage stacking Integra dermal substitute directly onto the exposed bone to provide both finger bulk and soft tissue coverage.The patient displayed no functional limitations three years post-surgery.For instances when local or distant flap coverage may not be feasible, we present a novel technique to reconstruct, provide bulk, and preserve length in pediatric finger amputations. This case highlights that the utility of dermal substitutes is expanding and are providing more technical options.
摘要：
与成人同行相比，儿童的手指截肢面临着独特的挑战，需要特别的考虑。最大化长度并保持指尖体积和感觉对于保持功能性手指至关重要。合成真皮替代品最近已用于软组织覆盖小儿并指以及烧伤；然而，讨论骨水平近端软组织损伤的小儿截肢病例的文献有限。在这种情况下,我们报道了一名2岁的患者,她的右手食指在多次兔咬伤后出现了干性坏疽,并通过远端指间关节进行了截肢.需要在中指骨尖端附近进行周向软组织清创术，留下大量裸露的骨头，没有软组织包膜。我们报告了将Integra真皮替代品直接堆叠到裸露的骨骼上的经验，以提供手指体积和软组织覆盖。患者在手术后三年没有表现出功能限制。对于局部或远处襟翼覆盖可能不可行的情况，我们提出了一种新的重建技术，提供散装，并保留小儿手指截肢的长度。这一案例突出表明，真皮替代品的效用正在扩大，并提供了更多的技术选择。
