title: Digital avulsion with compromised vascularization: study of 23 cases in children.
abstract: 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.
authors.affiliation: Department of Pediatric Orthopaedic, Robert Debré Hospital, AP-HP, Paris 7 University, Paris, France. yan.lefevre@chu-bordeaux.fr
authors.forename: Yan
authors.initials: Y
authors.lastname: Lefèvre
authors.forename: Cindy
authors.initials: C
authors.lastname: Mallet
authors.forename: Brice
authors.initials: B
authors.lastname: Ilharreborde
authors.forename: Pascal
authors.initials: P
authors.lastname: Jehanno
authors.forename: Jean Marc
authors.initials: JM
authors.lastname: Frajmann
authors.forename: Geoges-François
authors.initials: GF
authors.lastname: Penneçot
authors.forename: Keyvan
authors.initials: K
authors.lastname: Mazda
authors.forename: Franck
authors.initials: F
authors.lastname: Fitoussi
mesh_terms: D000293:Adolescent; D000673:Amputation, Traumatic / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005383:Finger Injuries / Q000145:classification / Q000473:pathology / Q000601:surgery*; D005385:Fingers / Q000098:blood supply / Q000473:pathology / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D008866:Microsurgery / Q000379:methods; D011379:Prognosis; D012092:Replantation / Q000379:methods*; D012189:Retrospective Studies; D014022:Tissue Survival; D016896:Treatment Outcome