Postoperative Interventions in Pediatric Digital Replantation: A Tertiary Referral Center Case Review. J Hand Surg Am 2024 Mar;49(3):276.e1-276.e9
Date
08/20/2022Pubmed ID
35985864DOI
10.1016/j.jhsa.2022.06.016Scopus ID
2-s2.0-85136088002 (requires institutional sign-in at Scopus site) 1 CitationAbstract
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: Therapeutic IV.
Author List
Larson EL, Lieb MW, Pysick HE, Mehdi M, Hoben GMAuthor
Gwendolyn M B Hoben MD Assistant Professor in the Plastic Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdultAmputation, Traumatic
Anesthetics
Anticoagulants
Child
Finger Injuries
Humans
Postoperative Care
Replantation
Retrospective Studies
Tertiary Care Centers
