Complications and Pitfalls after Finger Replantation in Young Children

Abstract

This is a retrospective cohort study. The authors report surgical outcome in a series of very young children who underwent finger replantation after traumatic amputation. During a 10-year period, 65 children were treated with replantation for finger amputation in two institutions. This study focused on replantation of 15 fingers in 13 young patients under 6 years of age (mean age: 2.9 years; range: 1.1-5.7 years). Early postoperative complications were categorized into major or minor. At the time of assessment, the authors evaluated everyday life activities, pain and cold tolerance, total active range of motion (TAM) in patients with successful replantation, and growth disturbance. The overall success rate for children younger than 6 years was 47% (7 out of 15), and the authors had 67% of major complications, mainly in patients with crush injuries. There was venous ischemia in 13 (86%) fingers treated with controlled bleeding. The hemoglobin level decreased more than 2 g/dL in six patients, and blood transfusion was necessary in two patients. At the last follow-up, patients with successful replantation had a mean TAM of 72%. Despite numerous complications mainly in relation with venous congestion, the functional outcome is satisfactory after successful replantation in young children, which should always be attempted. Level III, case series, therapeutic study.

Outcomes of Digit Replantation in Children: A Systematic Review

“…8,11,13–15,17,23,25,26 Across 14 studies, 190 digit replantations were secondary to clean-cut injuries, 9,11,12,14–16,18–21,23–26,28 Another 154 digit replantations across 10 studies were secondary to crush injuries, 10–12,15,18,20,22,24,25,28 and 138 digit replantations across 13 studies were secondary to avulsion injuries. 9,10,12,18,19,21,23–28 The type of injury preceding digit replantation was not reported in four studies. 8,13,14,17 When classified by Tamai zones, 168 digit replantations were reported at Tamai zone I across 11 studies, 10,11,13,15,16,18–20,22,24,28 140 digit replantations were reported at Tamai zone II across 13 studies, 8–13,15,16,18,20–22,24 121 digit replantations were reported at Tamai zone III across 12 studies, 8–13,15,17,20–22,24,27 and 62 digit replantations were reported at zone IV across eight studies.…”

“…8–28 The timeframe of patient recruitment in included studies ranged from 1973 to 2020, where 13 studies included patients who were recruited before the year 2000, 8–12,15,17,20,21,23,25,27,28 and 10 studies recruited patients who were recruited onwards of the year 2000 (Table 1). 10,13,14,16,18,19,22,24,26,27 The mean age of patients across included studies ranged from 1.3 to 11.7 years old. The proportion of male patients across included studies ranged from 46% to 87%; hence, the proportion of female patients ranged from 13% to 54%.…”

“…8,11,[13][14][15]17,23,25,26 Across 14 studies, 190 digit replantations were secondary to clean-cut injuries, 9,11,12,[14][15][16][18][19][20][21][23][24][25][26]28 Another 154 digit replantations across 10 studies were secondary to crush injuries, [10][11][12]15,18,20,22,24,25,28 and 138 digit replantations across 13 studies were secondary to avulsion injuries. 9,10,12,18,19,21,[23][24][25][26][27][28] The type of injury preceding digit replantation was not reported in four studies. 8,13,14,17 Wh...…”

“…9,10,12,18,19,21,[23][24][25][26][27][28] The type of injury preceding digit replantation was not reported in four studies. 8,13,14,17 When classified by Tamai zones, 168 digit replantations were reported at Tamai zone I across 11 studies, 10,11,13,15,16,18-20,22,24,28 140 digit replantations were reported at Tamai zone II across 13 studies, [8][9][10][11][12][13]15,16,18,[20][21][22]24 121 digit replantations were reported at Tamai zone III across 12 studies, [8][9][10][11][12][13]15,17,[20][21][22]24,27 and 62 digit replantations were reported at zone IV across eight studies. 8,9,12,20,21,24,27,…”

“…14 No studies reported on postoperative anticoagulation. Thirteen studies reported performing venous anastomosis in some digit replantation patients, 10,12,14,15,[17][18][19]21,22,24,[26][27][28] and six studies reported performing arterial anastomosis in some digit replantation patients. 10,16,18,19,21,27 Only one study reported on artery size, recording a mean diameter of 0.4 mm.…”