Replantation In Children Research Articles

Outcomes of Digit Replantation in Children: A Systematic Review

Background: Children have been suggested to benefit from digit replantation due to a greater neurogenerative capacity. We aimed to conduct a systematic review on digit replantation in children to provide a comprehensive overview of survival rates and functional outcomes. Methods: A systematic literature search was conducted on Ovid MEDLINE, Embase, and the Cochrane Controlled Register of Trials for studies published between 1980 and 2023. We included peer-reviewed studies reporting on digit survival rates in pediatric patients under the age of 18 years who underwent single or multiple digit replantations distal to the metacarpophalangeal joint. Preoperative, intraoperative, and postoperative outcomes were extracted, and pooled estimates were derived using univariable analysis. Results: Twenty-two studies reporting on 761 patients and 814 digit replantations were included in our study. Most replantations occurred in the index (n = 74), Tamai zone I (n = 168), and from clean-cut injuries (n = 190). The mean survival rate was 76% (n = 618/814), with a mean range of motion at the distal interphalangeal joint ranging from 64 degrees to 90 degrees and two-point discrimination ranging from 3.8 mm to 6.4 mm. Compared with clean-cut injuries, digit replantations from avulsion [odds ratio (OR), 0.81; 95% confidence interval (CI), 0.74–0.89] or crush (OR, 0.71; 95% CI, 0.59–0.82) injuries were associated with a lower odds of survival. Digit replantations performed with two venous (OR, 1.43, 95% CI; 1.28–1.59) or arterial anastomoses (OR, 1.65; 95% CI, 1.48–1.81) were associated with a higher odds of survival. Conclusions: Our systematic review suggests that digit replantation may be a viable option in children. Further research is required to explore functionality after digit replantation in diverse pediatric populations.

Results of central ray metacarpal resection after failure of digit replantation in children

Central ray amputation results severe esthetic blemish and functional and psychological sequelae. Three main reconstruction procedures have been reported in adults: digital translocation, intracarpal osteotomy, and metacarpal resection; none of these, however, have been studied in children. The aim of this study was to report medium-term results for treatment of central ray amputation by proximal metacarpal resection following failure of digit replantation in children (i.e., skeletally immature patients). All children consecutively operated on by metacarpal resection after failure of digit replantation for complete central ray amputation between 2012 and December 2017 were retrospectively included. The surgical procedure consisted in metacarpal resection through a palmar approach, with deep transverse metacarpal ligament reconstruction. At last follow-up, adjacent finger range of motion, pain, rotational deformity and grip strength were evaluated, as well as metacarpal laxity. Metacarpal migration index and metacarpal divergence were measured on standard X-ray. Eleven children with a mean age of 11 ± 8 years were included. At mean 18 ± 3 months’ follow-up, range of motion in adjacent digits was conserved in all cases, with no intermetacarpal laxity. Grip strength was 28% lower than for the contralateral side. Two patients showed rotational malalignment in extension, without functional impairment. In 4th ray amputation (n = 8), metacarpal migration index was decreased by 65% due to radial migration of the 5th metacarpal, but metacarpal divergence was conserved in all cases. Isolated metacarpal resection of the central ray for replantation failure is a reliable and safe procedure with good radiological and functional results in skeletally immature children.

Clinical analysis of replantation of finger degloving amputation in children

Objective To report the clinical treatment and efficacy of replantation of finger degloving amputation in children. Methods From January 2010 to December 2017, 10 cases (12 fingers) of finger degloving amputation were performed replantation in children aged 11 months to 3 years old. The clinical features, surgical precautions and postoperative efficacy of the injuries were retrospectively analyzed. Results Postoperatively 10 fingers survived and 2 fingers died. The postoperative follow-up period was 6 to 12 months. Among them, 2 fingers had mild lateral deformity of distal segment development and 1 finger had hypertrophic scar contracture. The other fingers had good shape and functional recovery. According to the evaluation criteria of replantation function of severed fingers issued by Hand Surgery Society of Chinese Medical Association, the results were rated as excellent in 7 fingers, good in 2 fingers, and poor in 3 fingers. Conclusion The characteristics of finger degloving injury in children are various. Individualized treatment during and after operation can achieve better clinical efficacy. Key words: Child; Replantation; Degloving amputation; Treatment outcome

Exploration for Suitable Vessels for Replantation in “The Middle-type” Fingertip Amputation in Early Childhood; A Follow-up to “Validity of Exploration for Suitable Vessels for Replantation in the Distal Fingertip Amputation in Early Childhood: Replantation or Composite Graft”

Introduction: Pediatric digital amputations are rare compared to adult cases. Although the indications for digital replantation in children are generally more liberal and aggressive, they become rather ambiguous when fingertips are involved, especially those of the fingertip at the level of mid nail bed (middle-type). Previously, we reported that exploration in pediatric (6-year-old and younger) middle-type fingertip amputation found suitable vessels for replantation in 50% of times but the result of subsequent replantation was always successful. Moreover, we experienced an overall success rate of 67% in exploration cases including those of subsequent replantation with suitable vessels and composite grafting without suitable vessels. This was higher than a success rate of 57% in cases treated with primary composite grafting without exploration. Recently, we have encountered four additional cases of pediatric middle-type fingertip amputation. Therefore, we reviewed and re-analyzed all our cases to verify the value of exploring suitable vessels for digital replantation over primary composite grafting, especially in early childhood, as a follow-up to our previous report. Method: A retrospective review of cases involving the surgical treatment of young children (6 years or younger), with single-digit complete middle-type fingertip amputations from 1993 to 2016 was conducted. Cases were divided into two groups: cases underwent reattachment as composite graft primarily and cases underwent exploration for suitable vessels for replantation. In the latter group when suitable vessels for replantation were found, replantation was attempted. On the other hand, when no suitable vessels were found, amputated parts were treated as secondary composite graft with or without pocket method. The success of replantation or reattachment as a composite graft was judged on the basis of the clinical records. Results: A total of 17 consecutive cases were identified, including 13 cases that were previously reported and four new cases. Of the four new cases, replantation was successful in three cases, while simple composite grafting failed after exploration in the other case. The probability to find suitable vessels increased to 60% with the addition of three successful replantations. However, the overall success rate for vessel exploration (70%) did not show statistical significance compared to that of primary composite grafting (57%). Conclusion: We, again recommend exploration for amputations at this level with a view to replantation. Where microsurgical replantation is not possible, the use of the pocket technique can lead to a higher chance of graft survival.

Crown-Root Fracture Management by Therapeutic Extraction and Intentional Replantation in Children

Intentional replantation is in practice from past many years as a treatment option for pulpless teeth and also an effective treatment option for teeth which are difficult or impossible to treat using the conventional root canal therapy The preservation of periodontal ligament vitality the removal of all tissue debris and irritating substances from the root surface establishment of a good apical seal and reinforcement of the crown structure are crucial in establishment of the normal function of the reimplanted tooth This procedure should be considered as an alternative to tooth extraction A case of vertical crown root fracture of a permanent maxillary central incisor treated with intentional replantation is reported in this article At the two year recall visit the patient was asymptomatic The tooth was still in function and radiograph showed no evidence of pathological changes

Digit replantation in children: a nationwide analysis of outcomes and trends of 455 pediatric patients.

The short-term outcomes of pediatric digit replantation have been derived primarily from single-center/surgeon experience. The purpose of this study was to conduct a nationwide analysis of outcomes and trends of pediatric digit replantation as compared to adult patients. Digit replantation patients were identified in the 1999-2011 Healthcare Cost and Utilization Project, Nationwide Inpatient Sample. Outcomes included in-hospital procedure-related and total complications, microvascular revision, amputation, and length of stay (LOS). Univariate and multivariate analyses were performed to compare pediatric and adult patients and to identify independent predictors of outcomes. The annual rate of replantation among pediatric digit amputation patients was evaluated over the study period. A total of 3,010 patients who underwent digit replantation were identified, including 455 pediatric patients. For all replantations, age ≤18years was associated with a lower likelihood of suffering a total complication (odds ratio (OR) 0.66, P = 0.006), requiring amputation (OR 0.62, P < 0.001), and experiencing LOS >5days (OR 0.77, P = 0.019), after adjusting for comorbidity, amputation severity, digit type, number of replantations, and hospital characteristics. Similar associations were observed between patient age and replantation outcomes for single-finger replantations. The rate of pediatric replantation (range 16 to 27%) remained consistent through the study period (incidence rate ratio 0.98, P = 0.06). The rate of pediatric replantation has been relatively low, being 27% at most in a given year. Importantly, short-term outcomes are better in children than for adults, supporting the indication to perform replantation in this age group when the surgeon feels that replantation is feasible and safe.

Foot replantation in children: a case report

A Revista Brasileira de Cirurgia Plástica é o órgão oficial de divulgação da Sociedade Brasileira de Cirurgia Plástica (SBCP), tem como objetivo registrar a produção científica em Cirurgia Plástica, fomentar o estudo, aperfeiçoamento e atualização dos profissionais da especialidade.

Unfavorable factors of digital replantation in children and the relevant nursing strategies

Objective To investigate the characteristics,methods,and clinical effects of nursing for children undergoing digital replantation.Methods The data on nursing for 37 pediatric patients who had undergone digital replantation during the period of July July 2010 to July 2012 were analyzed.Of the 37 patients,35 had poor compliance,32 had emotional instability,31 had unstable body temperature,and 11 had vascular crisis.The parents of 35 children lacked of a knowledge about daily care.The nursing measures including sedation,immobilization,keeping warm,non-smoking,and early family health education were taken.Results Arterial embolization and necrosis in the replanted finger developed in one child and venous thrombosis and necrosis occurred in one patient.The inplanted fingers survived in 35 children,with an overall survival rate of 95.2％.Conclusions It is difficult for pediatric patients undergoing digital replantation to cooperate with treatment and nursing care.The factors affecting the healing and functional recovery are various and complicated and thus nursing is difficult.Application of sedation,immobilization,keeping warm,non-smoking,family health education can obtain a satisfactory efficacy. Key words: Severed finger; Replantation; Nursing

Fingertip replantation at or beyond the nail base in children

Although success of digital replantations in children has been reported by many authors, the very distal fingertip replantation remains technically demanding. The aim of this article is to review our experience with fingertip replantations at or distal to the nail base in pediatric patients and evaluate the clinical outcomes. From October 2000 to May 2007, 12 pediatric fingertips amputated at or distal to the nail base were replanted. Only one artery was anastomosed for revascularization with or without nerve repair; vein drainage was provided by the controlled bleeding technique. Eleven of the 12 replants (91%) survived; one replant of crushed digit failed. An average of 26 month (range, 6 to 36 months) follow-up revealed excellent restoration of finger motion and appearance. The regained static 2-point discrimination (S2PD) sensation was from 3.2 to 5.0 mm (mean, 4.2 mm). Both the parents and the children were satisfied with the final results. In conclusion, fingertip replantation in children allows good functional and esthetical recovery and should be attempted if technically feasible.

Adjacent and spontaneous neurotization after distal digital replantation in children.

In an exclusively pediatric population, this retrospective study examined the functional and aesthetic results after distal replantation without nerve suture. The aim was to demonstrate, in the child, the presence of spontaneous nervous regeneration resulting in a fingertip pulp with discriminatory sensation. Eight amputations in eight children with a mean age of 9 years and 2 months on the day of the accident were reviewed. The cases were managed by a single surgeon over a period of 8 years and were collected from two different hand centers. The patients were then examined by a different surgeon, and the data were collected. Sensibility was evaluated using the Weber, Semmes-Weinstein, and wrinkle tests. The results were excellent, with mean values of 4.6 mm for the Weber test, 3.3 for the Semmes-Weinstein test, and a positive wrinkle test in all subjects. All patients thus recovered discriminatory sensation with minimal aesthetic sequelae. The usual factors adversely affecting the results of the replantation (ischemic time, level and mechanism of the amputation, and quality of the venous return) were examined, but no statistical analysis was performed because of the small sample size. This study demonstrates the presence of the clinical phenomenon of adjacent neurotization in the absence of nerve repair. It thus confirms that children are excellent candidates for replantation of the distal extremities, even when nerve suture is not performed.

Adjacent and Spontaneous Neurotization after Distal Digital Replantation in Children

Adjacent and Spontaneous Neurotization after Distal Digital Replantation in Children

Digital replantation in children

Digital amputations in children can frequently be reconstructed using microvascular replantation techniques. An adequate preoperative assessment of the patient and amputated part is important to define associated trauma and to determine the candidacy for replantation. Preoperative care of the injured extremity and patient, as well as optimal perioperative medical and surgical management, increases the success of these microsurgical procedures.

幼児指末節部切断に対する治療経験

The finger tips of children are not only important for the function of the hand, but also important cosmetically. In our department, 10 digits have been treated since 1982.This included 8 males and 2 females, with mean age of 2.9. In these cases, 8 digits were complete and 2 digits were uncomplete amputation. The cases were classfied into 4 types according to the Ishikawa method (subzone I-3, II-2, III-3, IV-2). Replantation were performed on 4 digits, and composite graft on 4 digits. The other 2 digits were treated by skin graft and ointment. The survival rate in replantation cases were 100%. The complete survival rate in the composite graft cases were 25%. In these cases except replantation cases, many had nail defomities. We think that the indication of replantation in children is subzones III and IV and the indication of composite graft in children is subzonse I and II.

Digital replantation in children: A long-term follow-up study

Twenty-six children aged from 14 months to 12 years had a total of 44 amputated digits replanted in our hospital between May 1979 and May 1985. The length of follow-up was from 9 to 15 years (average, 11 years). Among the 43 surviving digits, the mean total active motion of the thumb and fingers was 130 degrees and 151 degrees, respectively. Sensibility recovery was excellent, with normal 2-point discrimination in 88%. A mean of 19 of 20 preselected activities of daily living could be accomplished. Relative grip strength was 79% that of the normal side and the relative pinch strength was 88%. Cold intolerance was slight or moderate in 40% of patients, and slight atrophy was present in 12 digits. Angulatory deformity or malalignment were remodeled. The circulatory status of the replanted fingers was excellent in 88% of digits and good in 12%. Bone growth had a mean relative length of 93% of normal in digits without joint involvement and 88% in those with joint involvement. Assessed with Nakamura Tamai criteria, the results were excellent in 25 cases (96%) and good in 1. All patients and their parents were satisfied with the results of the digital replantation.

Replantation. Indication and organization

Although expierence in replantation surgery increased during the past 30 years, there are still problems remaining. Refinement of microsurgical operations and improvement in rehabilitation technique have lead to superior functional results. Beside clear indications as thumb loss or replantation in children there are only few absolute contraindications. A retrospective analysis of more than 300 replantation showed that there are still problems concerning exhaustive supply of replantation centres. Because time is one of the many critical components of succesful preplantation improvements are necessary in extra- and intrahospital organization of replantation surgery.

Replantation in children

The rates of survival of the amputated part and the functional outcomes were studied retrospectively after 13 replantations and 12 revascularizations in 25 children. The ages of the patients ranged from 2 to 15 years (mean, 6.4 years). The average duration of follow-up was 4.2 years (range, 2 to 7 years). The survival rate was higher after revascularization (94.6%) than after replantation (84.6%). Sensory recovery of all digits was satisfactory. The mean growth rate of replanted digits relative to contralateral digits was 80%. Functional results were rated as excellent in 11 cases, good in 8 cases, moderate in 2 cases, and poor in 1 case. In order to prevent functional and growth disturbances and due to cosmetic reasons, replantation or revascularization should definitely be tried for children. © 1998 Wiley-Liss, Inc. MICROSURGERY 18:410–413, 1998

Replantation in children.

The rates of survival of the amputated part and the functional outcomes were studied retrospectively after 13 replantations and 12 revascularizations in 25 children. The ages of the patients ranged from 2 to 15 years (mean, 6.4 years). The average duration of follow-up was 4.2 years (range, 2 to 7 years). The survival rate was higher after revascularization (94.6%) than after replantation (84.6%). Sensory recovery of all digits was satisfactory. The mean growth rate of replanted digits relative to contralateral digits was 80%. Functional results were rated as excellent in 11 cases, good in 8 cases, moderate in 2 cases, and poor in 1 case. In order to prevent functional and growth disturbances and due to cosmetic reasons, replantation or revascularization should definitely be tried for children.

Major limb replantation in children

Major limb replantation in children

Replantation. Indications and organization

Although experience in replantation surgery increased during the past 30 years, there are still problems remaining. Refinement of microsurgical operations and improvement in rehabilitation technique have lead to superior functional results. Beside clear indications as thumb loss or replantation in children there are only few absolute contraindications. A retrospective analysis of more than 300 replantation showed that there are still problems concerning exhaustive supply of replantation centres. Because time is one of the many critical components of successful preplantation improvements are necessary in extra- and intrahospital organization of replantation surgery.

Replantation in childhood and adolescence. Long-term outcome

In 31 (out of 48) patients with 43 (out of 63) replanted or revascularized digits or parts of the extremities a study of long-term results was performed. Their ages were below 16 years at the time of injury. The results concerning function, sensitivity, cold intolerance, growth disturbance, patient acceptance and occupational changes were evaluated. Early complications consisted of venous stasis in 10.6% (n = 4), skin necrosis of the wound margin in 5.3% (n = 2) and in finger-tip necrosis in 5.3% (n = 2). One lower arm and one finger replanted (5.3%, n = 2) were lost after several revisions due to venous problems. In no case did arterial problems occur. Tendon adhesions were the most common complication in 28.9% (n = 11), followed by deviation of the axis in a frontal plane of more than 20 degrees in 13.3% (n = 5) and by joint instability in 5.3% (n = 2). Only twice (5.3%) did ankylosis or in another case osteomyelitis of the proximal phalanx result. At amputation level II (between the DIP joint and the nail root), 37.5% (n = 3) developed a reduction of range of active movement (RAM) with a mean of 31.7 degrees, and once an arthrodesis was necessary, whereas 50% (n = 4) of the patients have full range of active motion. At amputation level III (between the MP and DIP joint) 52.7% (n = 10) developed a reduction of RAM at the PIP joint with a mean of 29.5 degrees, and twice an arthrodesis was necessary, whereas 26.4% (n = 5) of the patients have full range of active motion. Of the patients 78.9% (n = 15) developed a reduction of RAM at the DIP joint with a mean of 35.7 degrees, and twice an arthrodesis was necessary. Only twice was ankylosis present, but 10.5% (n = 2) of the patients have full range of active motion. Excellent sensory recovery was observed with a mean dynamic two-point discrimination of 4.8 mm. In addition, only 29% (n = 9) of the patients report a surprisingly low incidence of cold intolerance, which is in contrast to adults with up to 100% cold intolerance in replanted digits. In 67.7% a radiologically measured difference of length with a mean of 3.8 mm and clinically measured a difference in the length of the digits with a mean of 4.9 mm was observed without complaints by the patients, instead, there was moderate discontent with the aesthetically disturbing fingertip atrophy, which was up to 30% in 48.4% of the patients. Of the patients who are now adult, 16.7% (n = 4) changed their choice of profession due to the trauma or because of the dissatisfactory result. These results and the success rate of 94.7% suggest the conclusion that one should not hesitate to perform a replantation or revascularization in children with even multiple amputations as the results are excellent.