Postoperative Interventions in Pediatric Digital Replantation: A Tertiary Referral Center Case Review
Retrospective cohort published in J Hand Surg Am (2022)
Abstract
PURPOSE: Although a few case series have been published describing the excellent outcomes of replantation and revascularization operations in children, there has been limited study of the hospital course that these patients experience and the number of potentially harmful interventions and treatments that occur. The purpose of this study was to detail the results of various postoperative interventions, including anticoagulation, transfusion, leeching, sedation, and additional anesthetic exposures. METHODS: Twenty-nine patients aged less than 18 years had 34 digital revascularizations or replantations performed between January 2000 and May 2020. The details of each patient's presentation, surgery, and postoperative care were analyzed. RESULTS: Nine of 29 children underwent repeat anesthetics, including 6 revision amputations. No demographic, surgical, or postoperative variables consistently preceded revision amputation or additional anesthetic procedures. Only 5 patients had >1 hemoglobin (Hb) measurement. Two patients received blood transfusions; the average drop in Hb was 3.5 g/dL from before surgery to the lowest after surgery. Four patients underwent leech therapy. Only patients receiving leech therapy required postoperative transfusions. Anticoagulation regimens were prescribed on the basis of demographic and surgical factors, although no medication or regimen seemed to affect outcomes. CONCLUSIONS: Although the experience of digital replantation is essentially the same in pediatric patients as adults, there may be different ramifications for children. Specifically, postoperative management of pediatric digital replantation or revascularization can involve multiple interventions that carry their risks. Parents should be counseled about the risks of anticoagulants, transfusions, and repeat anesthetics, and clinicians should monitor Hb closely when using leech therapy. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Resumen
29 pediatric patients (34 digits) underwent revascularization or replantation. Only patients receiving leech therapy required postoperative transfusions; mean hemoglobin drop was 3.5 g/dL. Parents should be counseled on additional risks of MLT.
Por qué esto importa para la hirudoterapia
This study detailed postoperative interventions in 29 pediatric patients (under 18 years) who underwent 34 digital revascularizations or replantations between January 2000 and May 2020, including anticoagulation, transfusion, leeching, sedation, and repeat anesthetics. Four patients received leech therapy, and notably, only patients who received leech therapy required postoperative blood transfusions; the average hemoglobin drop was 3.5 g/dL from before surgery to the lowest postoperative value. The authors recommend that clinicians monitor hemoglobin closely when using leech therapy and counsel parents about associated risks. The study offers useful observational data on leech therapy in pediatric replantation, but leeching was not the primary focus, the sample is small, no causal link between leeching and transfusion need can be inferred, and the authors note no variables consistently predicted outcomes.
Citación
Postoperative Interventions in Pediatric Digital Replantation: A Tertiary Referral Center Case Review.
Larson EL et al. · The Journal of hand surgery, 2022
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Añadido a la biblioteca ASH: May 26, 2026 · Última actualización del sitio: June 18, 2026