REPLANTATIONS IN CHILDREN AND YOUTHS - LONG-TERM RESULTS

In 31 (out of 48) patients with 43 (out of 63) replanted or revascular ized digits or parts of the extremities a study of long-term results w as performed. Their ages were below 16 years at the time of injury. Th e results concerning function, sensitivity, cold intolerance, growth d isturbance, patient acceptance and occupational changes were evaluated . Early complications consisted of venous stasis in 10.6 % (n = 4), sk in necrosis of the wound margin in 5.3 % (n = 2) and in finger-tip nec rosis in 5.3 % (n = 2). One lower a rm a nd one finger replanted (5.3 %, n = 2) were lost after several revisions due to venous problems. In no case did arterial problems occur. Tendon adhesions were the most c ommon complication in 28.9 % (n = 11), followed by deviation of the ax is in a frontal plane of more than 20 degrees in 13.3 % (n = 5) and by joint instability in 5.3 % (n = 2). Only twice (5.3 %) did ankylosis or in another case osteomyelitis of the proximal phalanx result. At am putation level II (between the DIP joint and the nail root), 37.5 % (n = 3) developed a reduction of range of active movement (RAM) with a m ean of 31.7 degrees, and once an arthrodesis was necessary, whereas 50 % (n = 4) of the patients have full range of active motion. At amputa tion level III (between the MP and DIP joint) 52.7 % (n = 10) develope d a reduction of RAM at the PIP joint with a mean of 29.5 degrees, and twice an arthrodesis was necessary, whereas 26.4 % (n = 5) of the pat ients have full range of active motion. Of the patients 78.9 % (n = 15 ) developed a reduction of RAM at the DIP joint with a mean of 35.7 de grees, and twice an arthrodesis was necessary. Only twice was ankylosi s present, but 10.5 % (n = 2) of the patients have full range of activ e motion. Excellent sensory recovery was observed with a mean dynamic two-point discrimination of 4.8 mm. In addition, only 29 % (n = 9) of the patients report a surprisingly low incidence of cold intolerance, which is in contrast to adults with up to 100 % cold intolerance in re planted digits. In 67.7 % a radiologically measured difference of leng th with a mean of 3.8 mm and clinically measured a difference in the l ength of the digits with a mean of 4.9 mm was observed without complai nts by the patients. Instead, there was moderate discontent with the a esthetically disturbing fingertip atrophy, which was up to 30 % in 48. 4% of the patients. Of the patients who are now adult, 16.7 % (n = 4) changed their choice of profession due to the trauma or because of the dissatisfactory result. These results and the success rate of 94.7 % suggest the conclusion that one should not hesitate to perform a repla ntation or revascularization in children with even multiple amputation s as the results are excellent.