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Digital Avulsion With Compromised Vascularization: Study of 23 Cases in Children

Lefèvre, Yan MD; Mallet, Cindy MD; Ilharreborde, Brice MD, Ms; Jehanno, Pascal MD; Frajmann, Jean Marc MD; Penneçot, Geoges-François MD; Mazda, Keyvan MD; Fitoussi, Franck MD

Journal of Pediatric Orthopaedics: April/May 2011 - Volume 31 - Issue 3 - p 259–265
doi: 10.1097/BPO.0b013e31820fc620

Background Avulsion of a digit has not always been an indication for replantation because of extensive injuries. The advent of microsurgery changed this, permitting avulsed digit replantations with varying rates of success. The aim of this study was to analyze surgical management of finger avulsion injuries of an exclusively pediatric series.

Methods A retrospective study of children with finger avulsion injuries and compromised arterial circulation degloving or amputation, treated primarily in our institution between 1997 and 2007. Factors that could affect the outcome included demographic and clinical data, description of the lesion using Urbaniak's and Tamai's classification, technical data related to surgery, and results of revascularization were collected.

Results Twenty-three children with 23 digital injuries were identified as digital avulsions with compromised vascularization. The mean age was 11 years and 8 months (range, 2 to 15 y). Four cases involved devascularization classified as Urbaniak 2 and the other 19 cases involved amputation or complete degloving, classified as Urbaniak 3. In 7 cases, replantation was not performed because of the extent of the lesions (all were classified as Urbaniak 3). The complete survival rate when revascularization or replantation was attempted was 25%. One case required a new procedure 6 days after the first surgery with a trans-P2 amputation. Injuries classified as Urbaniak 2 had an overall survival rate of 75% and injuries classified Urbaniak 3 had an overall survival rate of 5.3%.

Conclusions The global rate of survival after revascularization or replantation of avulsed fingers in children seemed to be poor. Urbaniak classification is an important prognostic factor with a good prognosis for lesions classified as Urbaniak 2 and a very poor prognosis for lesions classified as Urbaniak 3.

*Department of Pediatric Orthopaedic, Robert Debré Hospital, AP-HP, Paris 7 University, Paris

Department of Pediatric Surgery and Orthopaedic, Children's Hospital, CHU de Bordeaux-University Bordeaux 2, Bordeaux, France

None of the authors received financial support for this study.

Reprints: Yan Lefèvre, MD, Departement of Pediatric Surgery and Orthopedic, Children's Hospital, CHU de Bordeaux, Place Amélie Raba Léon, 33076 Bordeaux Cedex, France. e-mail:

Copyright © 2011 Wolters Kluwer Health, Inc. All rights reserved.