[Replantation of 45 digits in 26 children: a long-term follow-up]

Twenty eight children with 47 amputated digits were replanted by the authors from 1978 to 1985. Among them 18 cases with 37 replanted digits was from 1 to 4 years old. The average age was 4.3 yrs. Forty six digits were salvaged, with survival rate of 97.8%. Twenty-six cases with 45 replanted digits have been examined from 9 to 15 years postoperatively. The follow-up rate was 92.8%. The hand functions assessed by criteriae of nakamura and tamai were excellent in 24 and good in 2 with out fair or poor grade. The two-point discrimination discrimination distance between 2-4 mm was 85%, The long term cosmetic appearance were good. The pulps of fingers were full and had rich blood supply. The satisfactory rate amounted to 96%. The excellent result obtained was due to strict adherence to the rules for replantation in childed cases: precise repair of all kinds of tissues and strict operative skill. The bone should be shortened less than 5 mm only. The follow-up X ray films taken from 9 to 15 years postoperatively showed the average shortening of the operated hand was 4 mm in comparison with the contralateral side. The lengths of the replanted phalanges were 3.8 mm shorter than the contralateral one. It means the absolute shortening during operation has no change while the lengths of the hand have some compensation in the process of growth. Those digits amputated at the interphalangeal joints had an average shortening of total hand length of 10.2 mm. Most joints were fused. The fact demonstrate that in joint amputation case the articular surface of proximal phalanx can be shortened while the distal articular joint surface should be preserved for preservation of epiphysis.