Digit replantation in infants and young children: determinants of survival

Thirty-three children under 34 months of age with 41 digits amputated over a 15-year period were reviewed. There were 3 primary amputations, 6 composite grafts, and 32 replantations. Twenty-one variables were evaluated for their influence on 4-week digit survival. The overall survival rate of 32 replanted digits was 69 percent. Favorable uncontrollable variables were clean-cut injury and body weight greater than 11 kg. Favorable controllable variables included more than one vein repaired, bone shortening, interosseous bone fixation, and vein grafting of arteries or veins. Forty-one percent of children required a blood transfusion. Children with trauma to more than one digit were most likely to be transfused (p < 0.05). The combination of prompt digit reperfusion after successful arterial repair and at least one successful venous anastomosis resulted in a 95 percent digit survival rate, significantly higher than the 0 percent survival of digits lacking one or the other of these features.