Treatment of Pediatric Fingertip Amputations by Chest and Palm Subcutaneous Pocket Techniques.

Background: Although chest and palm subcutaneous pocket techniques are effective for pediatric fingertip amputations, particularly in pediatric patients younger than 2 years of age, few studies exist due to the rarity of these injuries. We report the treatment outcomes at our institution and consider factors associated with graft survival. Methods: We reviewed pediatric patients younger than 2 years of age with fingertip amputations who underwent the chest and palm subcutaneous pocket techniques between 2013 and 2025. Collected data included age, completeness of amputation, Ishikawa classification, donor site and pocketing period, postoperative management after separation (wet or gauze dressing), and graft survival. Graft survival was classified as complete recovery or partial necrosis. Results: Six patients (7 digits) were included in the study. The mean age was 17.4 months. Five digits had complete amputations, and 2 had incomplete amputations. According to the Ishikawa classification, 1 digit was classified as subzone I, and 3 digits each were classified as subzones II and III. Donor sites included 5 digits on the chest and 2 on the palm. The mean pocketing period was 11.7 days. All digits survived; however, partial necrosis occurred in 3 digits (43%). The pocketing period was longer in the complete recovery group (13.5 versus 9.3 d), and the wet dressing method tended to be used more frequently. Conclusions: Chest and palm subcutaneous pocket techniques are useful for pediatric fingertip amputations; however, maintaining an adequate pocketing period and appropriate postoperative wound management may be beneficial for improving graft survival.