Digit Replantation in Infants and Young Children: Determinants of Survival

Analysis of prognostic factors in ring avulsion injuries

“…Complications after successful revascularization included flexion contracture (5 digits), cold intolerance (4), malunion (3), boutonniere deformity (1), fungal infection (1), nonunion (1), osteomyelitis (1), and PIP joint arthritis (1). Complications after amputation were hypersensitivity (12), neuroma (2), and quadriga syndrome (1).…”

“…[1][2][3] In ring avulsion injuries usually bones and soft tissues are damaged severely and reconstruction is challenging. In spite of the difficulties and the high rate of failure 1,3 the literature contains enough evidence to support attempts to repair those injuries.…”

Successful Replantation of a Finger in an 8-Month Old Child

“…2 In a review of 41 digital replants in 33 children under 34 months of age, the youngest case was in a 9.3-month-old child. 3 Large reviews of pediatric replantations do not describe successful procedures in children younger than one year of age. A review of records at our institution has shown this case represents our youngest successful replantation, and while a review of the literature demonstrates successful replantations of a thumb and a great toe in younger infants, this may be the youngest reported replantation of a finger.…”

Digital Avulsion With Compromised Vascularization

“…Nevertheless, several pediatric series have reported high survival rates ranging from 64.5% to 100% as reported in Table 3, with different mechanisms or no precision about the proportion of avulsions. 2,4,5,14,25 Saies et al 26 reported the main study about amputations in children including 120 cases with 73 amputations and 89 revascularizations in patients under 16 years of age. Differentiating the various mechanisms of injury, they reported a lower rate of survival after an avulsion or crush (53% after replantation compared with 63% in the overall series and 75% after revascularization compared with 88% overall).…”