This study evaluates the results of a group of children who underwent distal digital replantation without nerve repair to determine the return of sensibility in the replanted part. Eight patients aged 3-15 years at the time of the injury were evaluated at an average of 53 months following repair. All injuries were complete amputations distal to the DIP joint and proximal to the distal pulp. Repair was performed with artery-only replantation, distal subcutaneous bleeding with application of topical heparin for venous drainage, and no nerve repairs. Patients were evaluated by an independent examiner for cold intolerance, sensory abnormalities, inclusion or exclusion of the digit with activities, satisfaction, appearance, touch discrimination, static 2-pt. discrimination, Semmes-Weinstein monofilament testing, and wrinkling with warm water immersion. All of the patients experienced return of sensory discrimination in the replanted part. None of the patients excluded the digit. Two-point discrimination averaged 4.6mm (range, 3mm - 6mm). Semmes-Weinstein monofilament testing revealed a mean of 3.3 (range, 2.83-3.83). All patients displayed wrinkling of the replanted part with warm water immersion, although the test was performed at home and not independently observed. Age, length of follow-up, ischemia time, venous congestion, level and mechanism of amputation did not appear to affect the sensory outcome, although the sample size was too small to be amenable to statistical evaluation.
This paper adds to the existing body of literature regarding the generally excellent results observed in the treatment of peripheral nerve injuries in children. Despite very marginal vascularity and the absence of any direct nerve repairs, all of these patients experienced excellent sensory return without disabling secondary symptoms. Certainly, the very distal nature of the injuries, with a very short distance for neurotization of the cutaneous elements, contributed to the results. The results are clearly superior to those expected in similar injuries in adults surely due to the enormous regenerative capacity of the pediatric nervous system. The paper reinforces the principle of very liberal replantation criteria in children, even in absence of suitable nerve repair or venous anastomosis. It also supports the promotion of continued research into the physiologic factors which contribute to the regenerative capacity and plasticity of pediatric nerves.
Plastic and Reconstructive Surgery