Optimizing survival and long-term outcomes in complex pediatric digital amputations: a case report with a 6.5-year follow-up

INTRODUCTION: Digital replantation in young children with complex thermal-crush amputations presents significant challenges for long-term functional and aesthetic outcomes. CASE PRESENTATION: We report the case of a 1.5-year-old male who sustained complete thermal-crush amputations of the left index, middle, and ring fingers caused by an industrial sealer at 180°C. A modified micro-reconstructive strategy was utilized, featuring sequential optimization, length-preserving bone management (< 3 mm shortening) with extension fixation, and a targeted venous drainage protocol. OUTCOMES: All three digits achieved 100% survival. At a 6.5-year follow-up, the patient exhibited excellent sensory recovery, fully restored proximal interphalangeal joint motion, and robust epiphyseal growth without clinically significant longitudinal growth discrepancy. CONCLUSION: This targeted surgical strategy successfully navigates the challenges of severe thermal-crush injuries, yielding highly favorable long-term developmental and functional outcomes in a young child.