Replantation-Pediatric Replantation

Pediatric Replantation

Pdf Summary

Traumatic amputations in children are rare but can be caused by cutting/piercing injuries, machinery accidents, bicycle chain injuries, and door slams. Traditional teaching suggests that any amputated part in a child should undergo replantation, but only about 40% of cases actually receive replantation. Pediatric replantation differs from adult replantation in anatomy, physiology, mechanism of injury, and surgical technique. Care for a child with a traumatic amputation should begin at the scene of the accident, with priority given to the patient as a whole. Direct pressure and tourniquets should be used to control bleeding, and the amputated part should be wrapped in moist sterile gauze and placed in a waterproof bag in a bucket of ice. After arrival at the hospital, the amputated part and stump should remain bandaged until evaluation in the operating room. The child should receive resuscitation, including warming the patient, intravenous catheters, antibiotic prophylaxis, and tetanus prophylaxis if necessary. Surgical technique for replantation in children is similar to adults, but the physis should be preserved if possible. Composite grafting and microsurgical anastomosis can be used. Pediatric replantation has favorable outcomes compared to adults due to quicker healing, less scarring, better nerve regeneration, enhanced tendon gliding, and easier joint mobilization. The success rates of pediatric digital replantation have been reported to be as high as 97%. Proximal replantation is less favorable with a reported success rate of 77%. Understanding the differences in pediatric amputation is crucial for successful replantation and optimal outcomes.

Keywords

Traumatic amputations in children

cutting/piercing injuries

machinery accidents

bicycle chain injuries

door slams

replantation in children

anatomy and physiology in pediatric replantation

surgical technique for pediatric replantation

outcomes of pediatric replantation

differences in pediatric amputation