Finger amputations in children are different from finger amputations in adults. Children often get their fingers amputated by being slammed in doors or getting their finger caught in the hinge side of the door. In adult cases, the finger is not generally reattached if it is the only one detached. In kids, every attempt is made to reattach a single amputated finger.
When a finger has been amputated, you need to elevate the injury, applying ice to reduce the swelling and bleeding. Cover the wound with a dry dressing that is sterile if possible. Use a splint to immobilize the entire hand including the wrist. If the finger is cut off completely, wrap it In a moist sterile gauze and place in a watertight bag, putting the bag on ice. Don’t put the bag directly on ice as this can damage the amputated finger. Go to the emergency room right away.
Kids up to age 6 deserve to have even the tip of the finger reattached and the procedure is generally successful. Even if the fingertip has been reattached, it usually grows normally, even if the bone was exposed. This is especially true if the child is younger than 2 years of age. The finger may have a loss of feeling at first but eventually it can have a normal feeling and normal fingertip function. The risks of surgery include infection to the wounded area, poor healing of the amputated finger, loss of sensation or motion, and problems with the anaesthesia.
There are different ways of treating amputations of the tip of the finger. The surgeon can do a composite graft or conservative treatment, which means healing by secondary intent. In one study from 1986 to 1987 involving thirteen cases of fingertip amputations in kids from age 1 to 8 years old, twelve cases involved a composite graft being used to reattach the fingertip, while one was treated through secondary intent. Twelve of the kids were followed for up to 3-4 years. In three situations, the primary healing of the tip could be observed. In eight cases, partial necrosis occurred and superficial mummification of the fingertip happened before complete healing happened. Seven cases had a normal anatomical tip, but 4 had a bit of asymmetry.
The growth of the finger was identical to the uninjured side except in two cases, where there was a 2 mm loss of length when compared to the other side. The fingernails were normal at follow up even though nail bed injuries occurred in at least 90 percent of cases initially. Sensation had returned to normal at follow up visits and parents considered the end result to be excellent in 75 percent of cases and good in 25 percent of cases.
Another study looked at 21 cases of finger reimplantation in kids from 14 months to 10 years of age who had 32 digits traumatically amputated. The amputation levels ranged from proximal to distal. Of all 32 digits, only one digit failed to survive. This leads to a survival rate of 96.6 percent, The longest time of ischemia was 28 hours.