Extraanatomical Revascularization via Dermatodermal Fusion in Pediatric Proximal Fingertip Amputations: a cohort study

Background: Proximal fingertip amputations in zones 3 and 4, according to the Allen classification, pose a significant challenge in children due to the technical difficulty of performing microvascular anastomosis on small vessels.The goal of this study was to evaluate the effectiveness of dermatodermal fusion as an alternative method for revascularizing amputated fingertips in young children.Methods: In the current study we present a series of 10 children treated with dermatodermal fusion for proximal fingertip amputations with a mean age of 2.9 years range: 9 months to 7 years in one center between 2015 and 2024.Results: The average age of children with fingertip amputations in zones 3 and 4 was 2.9 years.The surgical technique involved partial-thickness dermabrasion of both the amputated fingertip and a donor site, followed by the fusion of these surfaces.Postoperative care included weekly dressing changes, with surgical separation performed once stable reperfusion was achieved, typically within 3 to 5 weeks.The results indicated a successful revascularization rate of 80%, with full regrowth in 8 out of 10 patients.Younger children demonstrated better outcomes, supporting the hypothesis that age is a significant factor in regenerative capacity.Discussion: Dermatodermal fusion offers a simple, effective approach to fingertip replantation, particularly when microsurgical resources are not available.Further studies with larger sample sizes are warranted.