Successful Thumb Replantation Following Dog Bite Avulsion Amputation in a 2-Year-Old Child: A Case Report and Literature Review

Introduction: Dog bite injuries are common, but dog bite avulsion amputations are rare, and in the pediatric population, they are even rarer. We report a successful thumb replantation in a 2-year-old girl following avulsion amputation from a canine attack, representing one of the youngest cases to date, and review relevant literature to emphasize the importance of multidisciplinary management. Case Report: A 2-year-old girl presented with a complete thumb avulsion at the proximal phalanx after a dog bite, having also sustained a prior bite 1 week earlier. The amputated digit underwent 5–6 h of cold ischemia and about 1 h of warm ischemia before microsurgical replantation. Multidisciplinary consensus involving plastic, orthopedic, and infectious disease consults supported replantation. The procedure included thorough debridement, skeletal fixation, vascular and nerve repair, with empiric broad-spectrum antibiotics. A localized infection at 20 days resolved with targeted intervention. At 18 months follow-up, the child achieved full functional recovery: Zero visual analog scale pain, restored grip strength, near-normal range of motion, and excellent standardized scores (Tamai, QuickDASH). Age-appropriate psychosocial adjustment was confirmed by the young child PTSD checklist and pediatric quality of life inventory. Conclusion: This case demonstrates that replantation can be feasible and successful in select pediatric dog bite-related amputations despite contamination, when supported by aggressive debridement and infectious disease–optimized care. The outcome highlights the regenerative capacity in children and reinforces the role of multidisciplinary management in expanding replantation indications for contaminated traumatic injuries. Keywords: Thumb replantation, dog bite injury, avulsion amputation, microsurgery, pediatric trauma, contaminated wound.