The Fingertips Of Young Human Children Can Regenerate If The Wound Is Not Closed And A Blastema Can Form

I have found from reading old library textbooks back in the University of Washington Health Sciences Library a few passages where surgeons talk about this phenomena where if you cut off the finger tips of young human children, they will actually regenerate back completely in some cases.

This actually seems reasonable to believe. At some level most living organisms have to have some type of regenerative ability if they have managed to survive for millions of years from injuries, inter-species fighting, and predators.

Here are the few sources which seem to validate this idea that in young children, they can regrow back parts of lost limbs

Source 1 – The doctor treated the injured finger for infection but, forgot to send the child along for surgery to seal up the end of the finger. What could have been a costly medical error turned out to be a Godsend for that child; over the next month, the finger grew back, much in the same way as a salamander will regrow lost limbs….Just by doing nothing and letting the body heal itself, by 1974 Illingworth had documented hundreds of cases of regenerated fingers in children….The criteria for this to happen are that just the tip of the finger be lost – the region from the fingernail down to the very first joint – and that the child be under eleven years of age. If the finger is sliced below the first joint then regeneration does not take place. If the skin is stitched back over the cut the finger will also not grow back. Also, the younger the child the quicker is the regrowth

Fingertip Amputations In Young Children

Doctors treat fingertip amputations somewhat differently in children younger than 6 years of age. After thoroughly cleaning and preparing an amputated fingertip, the surgeon may reattach it to the finger. The fingertip may continue to grow relatively normally, even if bone was exposed. This is especially possible in children younger than 2 years of age.

Source #2: OrthoInfo – Fingertip Injuries and Amputations – AAOS American Academy Of Orthopaedic Surgeons

Children with Severed Fingers

Children are more likely to heal an amputated digit, and more likely to have good function of a replanted finger. Therefore, every effort is made to reattached severed fingers, especially in young patients.

Results of Reattaching A Severed Finger

Modern surgical techniques have allowed doctors to reattach fingers with high rates of success. In fact, about 90% of reattached fingers are successful–meaning the finger is viable. That’s the good news. The bad news is that most reattached fingers have only about 50% of normal motion, many have significant deficits of sensation, and many have difficulty with cold tolerance. Often that’s better than not having the finger, but not always. It’s very important to only reattach fingers in appropriate situations, and not reattach the finger when a poor outcome is likely.

Source #3: Time Magazine – Medicine: The Regenerative Finger – Monday, Aug. 25, 1975

Source #4: Stanford Medicine

Read more: http://www.time.com/time/magazine/article/0,9171,913436,00.html#ixzz2UGaWXtQl

The Connection To Deer Antler Blastema

I remember reading about how the antlers in deers actually work to manage to grow in length every year and it seems that the basic principles apply in both situations. The post “The Connection Between Regenerating Deer Antlers and The PTHrP, PTH And IHH pathway for Cartilage Regulation, PTHrP Seems To Be The Answer (Big Breakthrough!)” was where I learned that the antler in the deer just happend to fall off and there is a rather bad wound that is left from the antler from falling off. That wound DOES NOT HEAL. instead, that wound is let to stay that way until a blastema forms. This is what I believe is happening to the fingertips of children, that if you don’t suture the wound area up, there would be blastemas which would develop and those differentiate into the multiple different types of cells needed for tissue regeneration.

Update 5/24/ 2013: After reading over the 3rd source from Stanford Medicine, I may be wrong about the blastema idea. The researchers states in a related article

The finding discredits a popular theory that holds that previously specialized cells regress, or dedifferentiate, in response to injury to form a pluripotent repair structure called a blastema.“…

We’ve shown conclusively that what was thought to be a blastema is instead simply resident stem cells that are already committed to become specific tissue types….

“The re-growth of amputated digit tips — a few millimeters in mice and up to the first joint in humans — is the only documented case of limb regeneration in mammals. We wanted to understand the basic mechanism of how this happens.”

“…damage to a digit tip is repaired by specialized adult stem cells that spend their lives quietly nestled in each tissue type. Like master craftsmen, these cells spring into action at the first sign of damage, working independently yet side-by-side to regenerate bone, skin, tendon, vessels and nerves. But just as you wouldn’t ask a mason to wire your house, or an electrician to put on a new roof, the division of labor among these stem cells is strict. Each is responsible solely for its own tissue type.

In contrast, the blastema theory invokes a new pluripotent cell type formed out of urgency from previously specialized cells. This jack-of-all-trades cell discards its former profession and instead jumps in to indiscriminately regenerate all the tissue types of the limb.”

This finding changes the current dogma of limb regeneration, from pluripotent blastema cells to tissue-specific stem and progenitor cells,” said Rinkevich.

“We found that each tissue type could only give rise to that type of tissue,” he said. “There was no cross contribution between tissue types or germ layers.” In other words, there were clear demarcations between areas of color that corresponded to structures such as the epidermis, tendon, nail, vessels, nerves and bone.

“I was extremely surprised,” said Rinkevich. “I began the experiment very eager to find something like a dedifferentiation or transdifferentiation phenomenon — that is, one tissue type becoming another. But this is clearly not the case.”

In addition to the blastema theory, there was one other possibility. Some researchers had suggested that stem cells circulating in the blood could contribute to this type of regeneration….

They found that the labeled cells did not contribute to the regenerated tissue, showing that circulating stem cells were unlikely to be involved in the regrowth of the limb.

Implications For Height Increase

I had thought that when I was beginning this paper to show that humans might have some intrinsic ability to regenerate limb tips like what we see with the deer antlers. The blastema is formed and that leads to longitudinal growth. If the bone tip of a finger is cut open, we might be able to choose not to close it, and it eventually leads to mesenchyme forming at the tip and pushing themselves up like how the secondary ossification layers push themselves away from the primary ossification layer during normal endochondral ossification. It seems that for humans to regrow appendages, there will not be any type of pluripotent blastema. There is no dedifferentiation or transdifferentiation, only that whatever stem cells that already there which was going to differentiate into their preprogrammed lineage cell types would do so, only now they would start to move towards where the wound was so that cell growth would happen in that area. Like the researchers said…”the division of labor among these stem cells is strict. Each is responsible solely for its own tissue type.”

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Articles like this one from CNN “Woman’s persistence pays off in regenerated fingertip” show that tissue engineering to regrow recently cut off appendages seem to be possible even in adults.

Sections from the article…

a relatively new procedure called tissue regeneration, which had made amputated finger parts grow back for other patients.

Dr. Stephen Badylak, the University of Pittsburgh physician who helped pioneer the procedure

made an appointment with Dr. Michael Peterson, an orthopedic surgeon in Davis

The therapy involved cleaning out the finger and removing scar tissue — a process called debridement — and then dipping her finger into MatriStem wound powder. After seven weeks of treatment, her fingertip grew back (as shown in the before and after photos above).

she’s had physical therapy to decrease tingling in her finger caused by severed nerves.

Another story from FOX NEWS “Doctors regenerate man’s finger”

a wound healing powder nicknamed “pixie dust.”

A couple of days later, right in Dr. Schwartz-Fernandes’ office, Altier’s wound was coated with a white powder that’s actually called Matri-Stem

in this case cells—to rebuild Altier’s fingertip, including nerves, nail and fingerprint. 

Researchers at the Wake Forest Institute for Regenerative Medicine in Winston-Salem, North Carolina gave us a first-hand look at how it works.

“We take a very small piece of tissue from the patient about half the size of a postage stamp,” Atala said.

It takes a month for those cells to multiply.

“The cells are placed on the biomaterial, and it’s like a sandwich. You have muscle cells on the outside; you have lining cells on the inside.”

That bio-material is like the steel beams of a building, shaping the organ.  It eventually disintegrates, leaving only the cells behind.

There was a few news reports that showed that the powder we are looking at is just extracellular matrix. It is made from pig’s bladders and comprises of proteins & connective tissue which have been traditionally used by surgeons to repair tendons.

The person that is pioneering this field known as Regenerative Medicine is Dr Stephen Bodylak, at University of Pittsburgh at the McGowan Institute for Regenerative Medicine. In the interviews, Dr. Bodylak says that in theory, one can regrow an entire limb that has come off. The US military has taken up on the theory to regrow limbs testing the miracle powder on soldiers who have been wounded in the wars.

Another doctor named Dr. Steven Wolf at the Army Institute of Surgical Research says that several different technologies for limb regeneration already exists.

The same video HERE Dr. Bodylak was going to insert esophagus tissue into a patient who lost a lot of material from throat cancer.

The thing that made me really interested is where the claim is made that ‘if stems cells can regrow arteries, then there is less need for surgeries”.

For more information on how to get the pixie dust as it is called, I have clipped pictures of the www.acell.com company’s information.

www.acell.com

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