Neurovascular Injuries and Amputations

The assessment and treatment of these injuries is largely similar to adults. The pediatric limb tolerates ischemia better than the adult limb. The digits may tolerate as long as 6-10 hours of warm ischemia and sometimes up to 24 hours of cold ischemia. The limiting factor is often the very small size of the pediatric neurovascular bundles, necessitating ultra-microscopic techniques.

Amputated parts have to be preserved by wrapping them directly in a waterproof polythene bag, which is then placed in another larger polythene bag containing ice. The amputated part must not come into contact with ice or any other liquid. If very contaminated, the amputated part can be thoroughly washed in sterile isotonic solutions like normal saline or lactated Ringer’s solution prior to packing.

The Sequence of Replanting an Amputated Digit Is

  • Debridement of the part
  • Identification of all the structures of the digit
  • Shortening the bones to get a stable fixation as well as one that permits easy bridging of all the soft tissue structures.
  • Fixing of the bones. If the digit is amputated through a joint, it is often better to trim off the articular cartilage and fuse the joint after appropriate bone shortening.
  • Repair of tendons (both flexor and extensor)
  • Repair of veins(at least 2 per digit)
  • Repair of nerves
  • Repair of arteries
  • Closure of skin

Aftercare of the replanted digit required very meticulous monitoring for the initial week to detect and quickly intervene in the event of any compromise to its viability. Once viability of the digit is assured, intensive physiotherapy is necessary to restore function.

For more information or to schedule an appointment please contact us at (502) 561-4263 or 1-800-477-4263. To request an appointment online, use our Appointment Request Form.

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