This study represents an honest appraisal of the treatment of digital avulsion in children. Over a 10 year span, 23 cases were collected. The injuries were classified according to the Urbaniak classification that was very prognostic. A class Urbaniak 1 injury has adequate circulation and typically treatment requires standard bone and soft care. The class Urbaniak 2 applies circulation inadequate and requires vascular repair to preserve viability. A class Urbaniak 3 is a complete degloving injury or complete amputation, which led to dismal results in their series.
The authors looked at their pediatric population and compared their results to those that have been reported in adults. The evaluation and treatment of the child was detailed in the article with standard microsurgical exploration and repair techniques. The authors attempted to repair at least two arteries and at least two veins to optimize their survival rate. The authors looked at their technical data and the total arc of motion following replantation.
The overall complete survival rate was calculated. In seven cases, replantation was not performed because of the extent of the injury, and all these were classified as Urbaniak 3. The complete survival rate after revascularization or replantation was only 25%. Injuries classified as Urbaniak 2 had an overall survival rate 75% and those classified Urbaniak 3 had an overall survival rate of only 5%.
Within the discussion section, the authors emphasize the difficulties with pediatric replantation. These include the mechanisms of injury, greater degree of vasospasm, and more aggressive attitude toward replantation in children. The authors’ results further emphasize that repair of as many arteries and veins can optimize the survival rate. The authors should be commended for this open and honest appraisal of replantation following avulsion injuries in children. When a child presents with an Urbaniak 3 injury, the parents should be given a pessimistic outcome regarding replantation, as only 5% of these injuries survived.