Can you give me some actual statistics on how often fingers accidentally cut off can be put back on successfully in children? I know that sounds gruesome but that’s what we are up against with our son. No one seems willing to give us some hard core, black and white facts.

Success rates reported in the published literature for replantation of fingers in children remain low (53 per cent). Despite some reports of low survival rates, there are others who have published studies with an 80 per cent success rate. In those cases, the reattached finger continues to grow as well.

In a recent study from a children’s hospital in France, hand surgeons who performed microsurgery in children with traumatic digital avulsion report their results for 23 patients. In one-third of the cases, they were unable to save the finger and the child was left with an amputated stump.

There may be some specific reasons why one child will have a successful result and another doesn’t. Looking back at the results and comparing them to the records of patients helped these hand surgeons identify key factors that predicted problems ahead.

These items are referred to as prognostic factors for survival. They included the number of arteries that can be recovered (two is essential), repairing torn blood vessels without a graft, and large sized blood vessels.

Only having one working artery to supply blood to the finger is linked with poor finger survival. Smaller damaged blood vessel have the worst prognosis for survival. Pain and anxiety reduce blood supply to the reattached finger because they cause spasming of the blood vessels. The net result is reduced blood supply to the replantation that is trying to heal.

Not too surprising is the fact that a long delay between the traumatic injury resulting in amputation and the reconstructive surgery needed to reattach the digit lowers the success rate. When both skin and bone must be reconnected, the risk of failure is greater.

Surgical management of such injuries is not always easy to plan out. Because of the many and varied factors just mentioned, making accurate statistical predictions about success versus failure is difficult. There may be times when an amputated finger in a child just cannot be replanted.

In some cases, the reattached finger takes beautifully. In those children who do not have a successful outcome, a second surgery to remove the dead tissue is required. Parents and children who are old enough to understand should be informed of the risks, factors predicting success or failure, and possible prognosis.