Saving Tiny Fingers: The Marvels of Super Microsurgery in Pediatrics

In a world where children’s curiosity often leads to accidental injuries, the realm of medical science continues to push boundaries to save tiny fingers with the help of super microsurgery. Injuries in children can be severe; in some cases, they can lead to damage to arteries, veins, and even bones. Sometimes, this results in a near-total crush amputation of the finger at the distal phalanges level, also known as Tamai zone 1, 2, 3. In such cases, timely reattachment of the arteries and veins is crucial to save the finger. When the finger is completely severed into two pieces, it is called total amputation.

Today, thanks to advanced surgical techniques and the dedication and expertise of surgeons, successful reattachment of severed fingers in children is possible with precision.

Addressing the Challenges in Young Children through Super Microsurgery

Given the extremely small size of the blood vessels in a young child, which are less than 1 millimeter in diameter, the operation presents unique challenges. This necessitates the use of advanced surgical techniques to ensure successful reattachment and restored functionality of the finger with a highly specialized form of microsurgery known as super microsurgery.

Super microsurgery involves using microvascular procedures to repair blood vessels, nerves, and lymphatics. It requires high precision and higher magnification than adult microvascular procedures. While most microvascular procedures in adults are carried out at 10 times magnification, super microsurgery requires up to 24 times magnification to ensure proper reattachment of the delicate vessels. Moreover, the procedure must be performed with extremely small surgical instruments, emphasizing the need for precise surgical skills, expertise, and knowledge of microvascular anatomy.

Understanding the Process

The reattachment is done with 11-0 Ethilon sutures, which are finer than human hair. The bone is stabilized using a wire. Revascularization allows restoration of perfusion to a body part or organ that has had ischemia. Conducted under general anaesthesia, the Surgery lasts about three to four hours. Once it is reattached, the blue and lifeless finger will regain blood flow and colour, turning pink and red, and beginning to perfuse and regain life immediately after the surgery.

Post-surgery, the finger must be monitored for 48 -72 hours to ensure no blockages and check the functioning of the arteries and veins. After this period, the finger will grow normally with the rest of the body.

Expert Comments and Words of Caution

Pediatric microsurgery offers hope and healing to little ones faced with traumatic injuries. Pediatric trauma cases, particularly replantation and revascularization cases, require timely access to a center equipped with super microsurgery capabilities. It is also important for parents to remember the following:
● Immediately rush to a hospital with specialized facilities if a child suffers a severe injury.
● Ensure the injured area is bandaged to control bleeding and protect the severed part. Wrap severed part in wet clean cloth kept in ice pack during transport.
● Seek treatment within four to six hours of the injury for the best chances of successful reattachment.

 

Authored By Dr. Karthik Shrinivas Tallam, Senior Consultant – Plastic and Reconstructive Surgeon, Manipal Hospital Varthur