Digital Replantation in Children
May Tove Hestmo, MD; Magne Rokkum, MD, PhD
Oslo University Hospital, 0424 Oslo, Norway
Microvascular surgery in children is technically challenging, but modern microsurgical techniques and well organized training of hand surgeons, have made replantation an effective method in managing children with finger amputations.
Between 1984 and 1998, 47 children with a mean age of 8.3 years were admitted to our clinic with totally 66 amputated fingers, 30 incomplete and 36 complete. The majority of the injuries happened at home between Friday and Sunday. Wood splitter, squeezing devices, Guillotine-cutter and circular saw , were the most common causes of injuries. There were only 2 avulsion injuries. The middle finger was the most common affected, followed by the thumb and ring finger.
We found an overall finger survival rate of 79%. The survival after revascularization was superior to replantation ( 87% versus 72%). The thumb had a better survival (86%) compared to the other digits (77%).
As in other studies, crush/avulsion laceration showed a lower survival rate when compared to Guillotine amputations. The level of the injury correlated with the survival. Injuries proximal to the PIP-joint showed superior results compared to injuries at or distal to the PIP- joint (p<0.05). Two arteries sutured were superior to one artery (100% to 77%). Similar results were found for the veins. Vascular compromise was seen in 34 digits, 17 were reoperated with survival rate of 82% and 10 were treated with leeches with a survival rate of 60%. 7 digits were not treated and later amputated.
At a follow up of 1-5 years after surgery, the overall functional result was excellent in 65%, good in 26% and fair in 9% of the fingers.
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