Adjacent and Spontaneous Neurotization after Distal Digital Replantation in Children

Abstract

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.

Fingertip replantation at or beyond the nail base in children

“…In another study by Faivre et al in seven pediatric replantations distal to the DIP joint, the bleeding technique was briefly depicted as with a small square of skin excised from the distal fingertip. 6 In our series, we stress the use of a transverse or an oblique fish-mouth incision at the pulp tip or opposite to the artery-repair pulp side in the belief that incisions so made could better relieve venous congestion. With the bloodletting, a couple of tips are: First, make the incision limited to the dermis layer to ensure oozing; deeper incision is not necessary.…”

“…8 In another study on sensory recovery of fingertip replantations without nerve repair, Faivre et al tested an average of 4.6 mm S2PD (3-6 mm) in the affected fingers in eight under 16-year-olds. 6 The authors concluded that good restoration of sensation was related to spontaneous nerve regeneration in children. In our series, we observed a better return of S2PD (average 4.5 mm, range 4.1-5.0 mm) in the non-nerve repair subgroup.…”

“…Previously, amputations distal to the nail root in children were mostly treated either by reattachment as a composite graft, 5 or cap-plasty, 6 or conservative dressing change. 7 However, these methods are unfavorable in that they will result in length loss or disfigurement of the affected fingers, 8 and the victims may suffer negative psychological effects of the dysmorphic outcomes later on in their lives.…”

Replantation of a Multi-level Upper Extremity Amputation

“…What's more, it may play a important role especially in younger patients [4]. Our case stated a replantation of upper extremity with associated a very rarely seen multi-level amputation type, the success of the replantation depends on the experienced surgeons' technology and functional training.…”

La replantation digitale chez l’enfant

“…2) ; les tendons extenseurs sont suturés au PDS 5/0 par un point en cadre et si possible un surjet superficiel de PDS 6/0 ; les deux nerfs sont suturés au 10/0 jusqu'à la moitié de la pulpe. Au-delà, la neurotisation de continuité permet à l'enfant de retrouver une sensibilité très proche de la normale sans qu'aucune réparation nerveuse ne soit faite [13].…”