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1979;64;1PediatricsLaurie J. Rosenthal, Mark A. Reiner and Michael A. Bleicher

Nonoperative Management of Distal Fingertip Amputations in Children

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ISSN: 0031-4005. Online ISSN: 1098-4275.

PrintIllinois, 60007. Copyright 1979 by the American Academy of Pediatrics. All rights reserved.by the American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village,it has been published continuously since 1948. PEDIATRICS is owned, published, and trademarkedPEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly publication,

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Rece ived for pub lica tio n O ct 17 , 1978 ; a cce p ted N ov 1 0 , 1 97 8 .R epr in t req ues t to (M .A .B .) C h ie f, D iv is ion ofPed ia tric Su rgery ,I)epa rtm en t o f Surge ry , Th e M ount S ina i Hospita l, 1 00 S t an dF ifth A ye , N ew York , N Y 10029 .

VO LUME 64 #{149 }U LY 1979 #{149}UMBER I

PED IATR ICS Vo l. 64 No . 1 Ju ly 1979 1

Pedia t r icsNonopera t i v e M anagem en t o f D is ta l F inge rtipAm pu ta tion s in C h ild renLau rie J . R osen tha l, M D , M a rk A . R e iner, M D ,and M ichae l A . B le iche r, M D

F rom th e D epa rtm en t o f G ene ra l S u rgery , D iv is ion o f Em e rgency Su rg ica l S e rv ices andD iv is ion o f P ed ia tr ic S u rge ry , The M oun t S ina i H osp ita l and C ity H osp ita l C en te r a tE lm hu rs t, N ew Yo rk

Success w ith the uncomm only recogn ized tech-n ique of no nopera tive m anag em ent of fin ge rtip am -pu ta t ions in c hild re n ha s p rom pted p re sen ta tion o ffour cases so trea ted in ou r institu tio n . P rev iou sly ,fingertips am putated d ista l to th e d is ta l in te rp ha-lan gea l jo in t have been observed to regenera te inch ild ren unde r 12 y ears o f ag e.2

MATER IALO ur pa tien ts w ere 1 , 2 , 4 , and 9 years o ld . T hey

had in ju red the thum b, m idd le , index , and sm allfingers , respec tive ly . T he lev els o f am pu ta tion ar eseen in F ig 1 . T hree in ju ries transsec ted the d is ta lb one . A ll cases w ere eva lua ted fo r ex ten t o f in ju ryand chosen fo r nonopera tive th erap y (F ig 2 ). T hewounds w ere c leansed w ith an tisep tic so lu tio n andd ressed w ith fine m esh absorben t g au ze im preg-n a ted w ith b ism u th trib rom ophena te 3% in p etro -la tum b lend (X erofo rm ) and s ter ile gauze b an dage .T o en co urage m ob ility , n o sp lin ts w ere u sed . D ress-in gs w ere changed on e w eek afte r in ju ry and b i-w eek ly therea fte r. A ll ch ild ren w ere free of pa inw ith in 24 hours a fte r trea tm en t. H ea ling began a tth ree w eek s and w as com ple ted 12 w eeks afte rin ju ry . G ood co sm etic and func tiona l resu lt w ith

F ig 1 . Com po site o f lev el o f am puta tion in each case.

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F ig 2 . Imm edia te po stin ju ry ap pearan ce of am puta ted(a ) thum b (b) sm all f in ger.

D ISCUSS ION

F ig 3 . A ppearance 1 2 w eeks afte r in ju ry of (a ) thum b(b) sm all finger.

2 F ING ERTIP AMP UTATION IN CHILDREN

regenera tio n of the fingertip inc lud ing na il w as ob -se rved in each ca se (F ig 3) .

D oug las and Illingw orth2 w ere am ong the earlypropo nen ts o f the n onsurg ica l m anagem ent o f ch il-th ens fingertip in ju r ies . D esp ite the ir w e ll-docu-m en ted su ccess w ith th is trea tm en t, it is no t w ide lypracticed . M any con tinue to advoca te re im plan-ta tion of the am putated tip , su tu re c losu re , o r sk ingra f t and flap app lic a tion to the am pu ta ted s tum p .H ow ev er, the se te chn iqu es sh ou ld be re serv ed fo rin ju r ies to th e pro x im al tw o pha langes or fo r d isa r-t icu la tion in ju ries w he re regene rat ion is n o t se en .

T h e o ld es t re co rded p atien t to sh ow fing ertipreg en era tion w as 1 1 years o ld .2 O u r o ldest pa tien tw as 9 years o ld . W e, the re fo re , a re re lu c tan t to

recomm end th is m ethod of non surg ica l the rapy inch ild ren o lde r than 1 1 y ears.

The p rospec t o f n on op era tiv e ap p ro ach to trea t-m ent is f requen tly m et w ith d ism ay , expressed no to n ly by the in ju red ch ild s paren ts, bu t a lso byphys ic ians and surgeon s. T h is d isb e lie f m ay be as-suaged by reassu ring the fam ily and by c itin g th esuccess here in and prev iou sly reported .

O u r ex pe rience w ith th e no nsu rg ica l m eth od co n-v inces us of it s p lace in the care o f fingertip am pu-ta tion . It is ou r hop e th at the m eth od wifi rece ivewide r accep tance and p rac tice , the reby d im in ish ing

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ART IC LES 3

th e m o rb id ity a ttend an t to th is comm on ch ildhood gertips in ch ild ren . J Pediatr Surg 9 :8 53 , 1974in ju ry . 3 . E lsahy N I: W hen to rep lan t a fingertip a fte r its co rn -

p lete a rn pu ta tio n. P last Recons tr Surg 60 :14 , 19 77REFERENCES 4. Fre ibe rg A , M ank te low R : T he K u tler rep a ir forfingertip am puta tio ns. P la st Reconstr Surg 50 :37 1 ,1. D ouglas B S: C onserva tiv e m anagem ent o f gu illo tine 19 72

ampu ta t ion o f the finger in ch ild ren . Aust P aedia tr 5 . R ank BK , W akefie ld A R , H ueston JT : Surg ery o fJ 8 :8 6 , 1972 - Repair as Applied to Hand Injurie s , Baltim o re , W il-

2 . I ll in gw o rt h CM : T rapped fingers and am putated fin - ham s & W ilk ins C o , p p 116 -137

GU IDEL IN ES FOR M ED ICA L RESEA RCH PA PERS

A . T o im prov e the m ed ica l s tud ie s be ing done :1. Ed ito rs sho u ld g ive pu b lica tio n p re ference to w ell-d ocum en ted rep o rts o f

con tro lled c lin ica l tr ia ls in stead of rep orts o f exc iting da ta from poorlycon tro lled stud ies .

2 . S tatis tic ians sho u ld be in vo lved a t the very beg inn in g of resea rch pro jec ts.B . T o im prov e the do cum en ta tio n in m ed ica l re sea rch p ap ers :

1. S tand ards gov ern ing the co n ten t and fo rm at o f sta tis tica l aspects shou ldb e deve lo ped to g u id e au tho rs in the p ub lic a t ion p o licy and sh ou ld beenfo rced by rev iew ers and ed ito ria l b oards .

2 . A ll raw da ta sho u ld be m ade ava ilab le fo r exam ina tion by in te restedreaders .

3 . In p ub lish in g reports o f uncon tro lled c lin ica l o bse rva tions , ed ito ria l bo ardssh ou ld e ith e r p rin t a w arn in g sec tion o r in sist tha t the au thor(s ) exp licitlysp e ll ou t the lim itations o f the study .

4 . A system for c lass ify ing m ed ica l a rticles b ased o n the qua lity o f the irsc ien tific ev idence shou ld b e deve lop ed . T he c lass ifica tion crite ria sh ou ldbe p rin ted in th e jo u rn als .

5. Edito rs shou ld re fra in from cu tting m ate ria l w h ich critica l readers need toeva lu ate the paper, and ed ito rs sh ou ld rep rod uce in grea t de tail thosepapers w hich are concerned w ith a reas o f con troversy o r uncerta in ty .

C . T o im pro ve th e ed ito ria l rev iew pro ce ss:1 . Jo urnaL s shou ld rec ru it b iom etrically soph is tica ted peop le as m anuscrip t

rev iew ers an d ed ito ria l board m em bers . T he B iom etric Soc ie ty shou ldhe lp id en tify such peop le .

2 . A uthors shou ld p rep are a de tailed exp osition concern ing m ethodo lo gy ,wh ich w ou ld n o t app ea r in p rin t bu t w ou ld be av ailab le to th e ed ito r andre fe rees w hen eva lua ting a m anuscrip t.

3 . E d ito ria l boards shou ld carefu lly cons ide r the qua lity o f th e s tu dy design ,p er fo rm ance , p resen ta tion s of resu lts, and ana lys is w hen eva lua ting amanuscr ip t .

D . T o im pro ve the cri tica l re ad in g ab ilitie s o f m ed ical jo u rn al re ade rs:1. S tatistic s courses fo r m ed ical s tuden ts shou ld p lace grea te r em phasis o nc ritic a l th in k in g and log ic in d ec is ion -m ak ing than on th e te ch n ic a l a sp ects

o f s ta ti st ic s .E . T o im prov e the qua lity o f mas s m edia rep o rts o f m ed ica l re sea rch :

1. The B iom e tric So cie ty sh ou ld sp on so r a w o rksh op fo r scien t if ic repo rte rs.S ubm it ted by S tu den t

F rom Shou ld there b e sta tis tica l g u id elines fo r m edic al research papers? (p ane l d iscus sion ).Biometrics 34 : 687 , 1978 ,

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1979;64;1PediatricsLaurie J. Rosenthal, Mark A. Reiner and Michael A. Bleicher

Nonoperative Management of Distal Fingertip Amputations in Children

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