Purpose
Although a few case series have been published describing the excellent outcomes of
replantation and revascularization operations in children, there has been limited
study of the hospital course that these patients experience and the number of potentially
harmful interventions and treatments that occur. The purpose of this study was to
detail the results of various postoperative interventions, including anticoagulation,
transfusion, leeching, sedation, and additional anesthetic exposures.
Methods
Twenty-nine patients aged less than 18 years had 34 digital revascularizations or
replantations performed between January 2000 and May 2020. The details of each patient’s
presentation, surgery, and postoperative care were analyzed.
Results
Nine of 29 children underwent repeat anesthetics, including 6 revision amputations.
No demographic, surgical, or postoperative variables consistently preceded revision
amputation or additional anesthetic procedures. Only 5 patients had >1 hemoglobin
(Hb) measurement. Two patients received blood transfusions; the average drop in Hb
was 3.5 g/dL from before surgery to the lowest after surgery. Four patients underwent
leech therapy. Only patients receiving leech therapy required postoperative transfusions.
Anticoagulation regimens were prescribed on the basis of demographic and surgical
factors, although no medication or regimen seemed to affect outcomes.
Conclusions
Although the experience of digital replantation is essentially the same in pediatric
patients as adults, there may be different ramifications for children. Specifically,
postoperative management of pediatric digital replantation or revascularization can
involve multiple interventions that carry their risks. Parents should be counseled
about the risks of anticoagulants, transfusions, and repeat anesthetics, and clinicians
should monitor Hb closely when using leech therapy.
Type of study/level of evidence
Case series, Therapeutic IV.
Key words
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Article info
Publication history
Published online: August 16, 2022
Accepted:
June 13,
2022
Received:
November 16,
2020
Publication stage
In Press Corrected ProofFootnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2022 by the American Society for Surgery of the Hand. All rights reserved.
