When it comes to traumatic injuries, children have amazing recuperative powers. In many situations, they heal faster with fewer problems than adults with the same injuries. One injury where this advantage may not hold true is with avulsion (traumatic amputation) of the digits (fingers).
Smaller blood vessels in children with digital avulsion injuries that get crushed or severely damaged don’t just spring back. The loss of blood supply to the area makes recovery with replantation (reattaching the finger) difficult. Success rates reported in the published literature on this topic remain low (53 per cent).
In this study, 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.
Looking back at the results and comparing them to the records of patients may help identify key factors that would predict problems ahead. These items are referred to as prognostic factors for survival.
One of the main prognostic factors was the number of arteries that could be reconstructed. Only having one working artery to supply blood to the finger is linked with poor finger survival. Being able to repair the blood vessels without using a graft contributes to a better outcome. And, as mentioned, the smaller the damaged blood vessel is, the worse the prognosis for survival.
Other factors that can have a negative effect on the results are the presence of pain, which in turn, increases anxiety. When pain and anxiety occur together, spasming of the blood vessels develops. The net result is reduced blood supply to the replantation (i.e., reattached finger). This development can also affect the replanted finger that is trying to recover.
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. 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.
The good news is that these days it is possible to perform replantation surgery for amputated digits (fingers). That wasn’t possible in years past. With the development of microsurgical techniques (using a very high-powered microscope) and special surgical tools, this type of surgery is both possible and successful now.
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.
The authors conclude there may be times when an amputated finger in a child just cannot be replanted. And by assessing all patient factors as described, it may be possible to predict when it is best to leave the amputation as is and close up the stump versus attempting replantation.