Upper limb digital replantation and revascularisation in children

Amputations in children are not common and experience in microvascular digital replantation in children is not extensive. We report our experience of ten digital replantations in eight children over a two-year period. Paediatric replantation with its minute anatomy is technically very demanding. Joints should be reconstructed, epiphyses preserved and bone shortening kept as minimal as possible. Complications are not more than those in adults. All the replanted digits in our series survived. Seven of the ten replanted digits were normal in size. Six of the eight patients regained good to excellent functional use of the replanted digits. All but three of the joints at and distal to the level of injury regained active motion ranging from 10 degrees to 70 degrees with an average of 42 degrees. One had primary fusion of the distal interphalangeal joint of his amputated index finger. All the preserved epiphyses had remained open at the last follow-up. Replantation in children may be technically difficult but is very rewarding. We had a high success rate with good functional return and continuing growth.