The Journal of Bone and Joint Surgery, Vol 76, Issue 12 1766-1776, Copyright © 1994 by Journal of Bone and Joint Surgery, Inc
Results after replantation and revascularization in the upper extremity in children
AD Saies, JR Urbaniak, JA Nunley, JS Taras, RD Goldner and RD Fitch
Division of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina 27710.
The rates of survival of the amputated part and the functional outcomes
were studied retrospectively after seventy-three replantations and
eighty-nine revascularizations in the upper extremity in 120 children. All
operations were performed between January 1974 and December 1988 after
partial and complete amputations at various levels. The ages of the
patients ranged from three days to sixteen years. The average duration of
follow-up was thirty-six months (range, fourteen months to seven years) for
the patients who had had a replantation and thirty months (range, fourteen
months to eight years) for the patients who had had a revascularization.
The rate of survival of the amputated part was significantly higher (p <
0.0002) after revascularization (seventy-eight parts [88 per cent]) than
after replantation (forty-six parts [63 per cent]). There was no
association, for either group, between survival and the preoperative
duration of ischemia, the level of the injury, the digit that had been
injured, the number of arteries that had been repaired, or the use of
venous grafts. The rate of survival after replantation of completely
amputated parts was 72 per cent (twenty-eight of thirty-nine parts) when
the amputation had resulted from a laceration injury and 53 per cent
(eighteen of thirty-four parts) when the amputation had resulted from a
crush or an avulsion injury. The rate of survival after revascularization
of incompletely amputated parts was 100 per cent (all forty-five parts)
when the injury had been the result of a laceration and 75 per cent
(thirty-three of forty-four parts) when it had been the result of a crush
or an avulsion. We did not find any relationship between the age of the
patient and the rate of survival of the amputated part after
revascularization; however, there was a significantly higher rate of
survival (p , 0.02) after replantation in children who were less than nine
years old (77 per cent [twenty-four of thirty-one parts]) compared with the
rate in those who were nine to sixteen years old (52 per cent [twenty-two
of forty-two parts]). The viability of the digit was in jeopardy after
twenty-nine (40 per cent) of the seventy-three replantations and nineteen
(21 per cent) of the eighty-nine revascularizations. Immediate reoperation
resulted in the salvage of only two of the twenty-one replanted parts and
six of the twelve revascularized parts that had a reoperation.(ABSTRACT
TRUNCATED AT 400 WORDS)
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