Comparative assessment of fingertip replantation in paediatric and adult patients within a single institution

Abstract

The purpose of this retrospective study was to compare the outcomes of paediatric and adult fingertip replantation within a single institution. Our retrospective study found no significant difference in the survival rate between the paediatric (10/12) and adult (22/26) groups. At 6 months follow-up, there was no significant difference in sensory recovery between both groups, as measured with Semmes–Weinstein testing, but a significant difference in mean static two-point discrimination testing values between the paediatric (4.0 mm) and adult (6.2 mm) groups. Moreover, the mean time for regaining sensation was faster in paediatric patients (1.3 months) as compared with adult patients (4.1 months). Five children and four adults received erythrocyte transfusion. Paediatric fingertip replantation has similar survival rates, faster and better sensory nerve recovery as compared with adults despite a higher erythrocyte transfusion rate. Although technically demanding, paediatric fingertip replantation is recommended, whenever possible, because of the good outcomes achievable. Level of evidence: IV

Outcomes of Digit Replantation in Children: A Systematic Review

“…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. 8,9,12,20,21,24,27,28 The level of amputation was not reported in six studies.…”

“…No studies reported range of motion at the proximal interphalangeal joint. Across eight studies reporting on the mean two-point discrimination of replanted digits, 8,14,16,[18][19][20]25,27 this value ranged from approximately 3.8 mm to 6.4 mm, with a mean of 4.4 mm. Three studies reported on the use of Semmes Weinstein testing in patients with replanted digits, 19,25,28 where the mean score ranged from 2.7 to 3.5, with a mean of 3.2.…”

“…The mean time from injury to surgery across included studies ranged from approximately 3 hours to 18 hours, where the bone length of the replanted digit was shortened at least minimally across all studies (Table 3). Thirteen studies reported performing tendon repair in some digit replantation patients, 9,13,[15][16][17][19][20][21]23,24,[26][27][28] 11 studies reported performing bone fixation using a Kirschner wire, [9][10][11][12]14,[17][18][19]21,22,25 eight studies reported performing nerve repair, 9,16,17,19,24,[26][27][28] and four studies reported performing vein grafting. 9,12,21,27 With respect to anticoagulation agents, the use of intravenous heparin intraoperatively was reported in eight studies, 11,12,15,[17][18][19]21,27 the use of heparin gauze was reported in two studies, …”

“…The digit survival rate of patients across included studies ranged from approximately 46.7% to 100%, where the overall digit survival rate pooled across all studies was 76%. Across six studies reporting on the mean range of motion at the distal interphalangeal joint (DIP) in replanted digits [14][15][16]18,23,27 ; this value ranged from 64 degrees to 90 degrees, with a mean of 83 degrees. No studies reported range of motion at the proximal interphalangeal joint.…”

“…9,12,21,27 With respect to anticoagulation agents, the use of intravenous heparin intraoperatively was reported in eight studies, 11,12,15,[17][18][19]21,27 the use of heparin gauze was reported in two studies, 24,29 and the use of heparin sponge was reported in one study. 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.…”