Pediatric digital replantations: regenerativedermis in a salvage procedure.

A 28 month-old male was admitted (April 2010) at our department for a complete amputation of the right thumb at the meta-carpal-phalangeal joint level due to a crush-avulsion injury. (Fig.1) The amputated stump was replanted with restoration of arterial and venous flow. After four days, an arterial thrombosis required a secondary revision of the original anastomosis. Nevertheless, in the following days a progressive necrosis of apical superficial cutaneous tissues was observed: surprisingly, underlying tissues were effectively vascularized in spot areas. Thus, an amputation at the inter-phalangeal joint was performed in association with a soft tissue coverage by means of a regenerative dermal substitute (INTEGRATM, Integra Life Sciences Corporation, USA) and, after three weeks, of a full thickness skin graft over the dermal substitute. At the 19-months clinical follow-up the skin graft appeared smooth and viable. Relative grip strength and relative pinch strength were comparable to those of the contra-lateral hand: the ability to accomplish preselected daily activities was preserved. Globally, we considered it an excellent aesthetic and functional outcome.