Pediatric digit replantation: A mixed methods outcomes study.

BACKGROUND: Indications for pediatric digital replantation/revascularization (replant/revasc) are broader than those for adults. Pediatric patients suffer many of the same challenges seen in adult replant/revasc patients with similar rates of digit salvage. The purpose of this study was to review the incidence of and long-term outcomes after pediatric replant/revasc. METHODS: Data was collected from medical records of patients presenting to our Level 1 Trauma Pediatric Hospital Emergency Room between January 2011 and March 2017. All charts with ICD-9 codes for upper extremity trauma were queried and reviewed. Additional data was collected on patients undergoing digit replant/revasc or revision amputation. Patients whose replant/revasc digits survived to the first post-operative visit underwent further outcomes assessment. RESULTS: Of the 1364 patients who presented with upper extremity trauma over the study period, 19 underwent replant/revasc and 12 digits survived to the first post-operative visit. 10 of the patients and their families participated in interviews (mean follow up 89 months (range 74-119) post-procedure). Children and parents had different perspectives on their treatment experience. Six patients reported excellent function with no limitations in schoolwork or sports. Nine patients and seven parents stated they would choose to undergo replant/revasc surgery again. CONCLUSIONS: Replant/revasc was often technically successful, albeit with difficult short and long-term courses. The majority of patients reported excellent function and return to normal activities; however, many reported ongoing negative physical and psychological outcomes. Future larger scale and comparative studies would improve our understanding of indications for and long-term sequelae of pediatric digit replant/revasc.