Salvage composite graft for an Allen’s IV right ring finger avulsion injury and delayed presentation in a 15-year-old boy

Journal of Orthopaedic Reports Pub Date : 2024-07-19 DOI:10.1016/j.jorep.2024.100446

Kenneth Pak Leung Wong, Mohammad Ashik bin Zainuddin, Arjandas Mahadev

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Abstract

Background

Older age, proximal injuries avulsion-type injuries and delayed reattachment (>4.3hours) are poor prognostic factors for complete survival of composite grafting in fingertip amputations. It has been recommended that bone be removed from the graft to improve survival rate. We herein describe a case of an older paediatric patient who sustained an Allen’s IV right ring finger avulsion injury with a delayed presentation.

Case report

A 15-year-old boy sustained a dominant right ring finger traumatic avulsion amputation unsuitable for replantation. The digit was reattached as a composite graft. The bone united and nail bed partially reformed allowing preservation of some length. The remainder tissue necrosed, however. This was debrided and covered with a cross-finger flap from the middle finger. Ultimate cosmetic and functional outcome were good.

Conclusion

This experience brings forth the option of length preservation by way of reattachment of the severed bone or even a cortico-cancellous autograft and subsequent local flap for skin coverage.

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一名 15 岁男孩的艾伦氏 IV 型右手无名指撕脱伤和延迟表现的救治复合移植术

背景较高的年龄、近端撕脱型损伤和延迟再连接（4.3 小时）是指尖截肢复合移植完全存活的不良预后因素。有人建议从移植物中移除骨头以提高存活率。我们在此描述一例年长儿科患者的病例，该患者的右手无名指被艾伦氏 IV 型撕脱伤，且延迟了手术时间。病例报告一名 15 岁男孩的右手无名指被外伤性撕脱伤截肢，不适合再植。该指骨以复合移植的方式进行了再植。骨结合和甲床部分重塑，保留了部分长度。但其余组织坏死。对其进行了清创，并用中指的交叉指皮瓣覆盖。最终的美容和功能效果都很好。结论：这一经验提出了通过重新接合断裂的骨头，甚至是皮质-结缔组织自体移植和随后的局部皮瓣皮肤覆盖来保留长度的选择。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Journal of Orthopaedic Reports

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