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Reimplantation and revascularization

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When part of a limb is amputated, or its blood vessels are interrupted, it is necessary to restore vascularization by reimplantation or revascularization, respectively.

In children, unlike adults, most amputated or devascularized segments are reimplanted because the odds of a successful outcome are higher.

In finger amputations, indications for reimplantation are when it affects the thumb, multiple fingers or a single finger distal to the distal interphalangeal joint (Fig. 12A-E, Fig 13A-B).

In more proximal amputations, hand or foot close to the root of the limb, depending on the conditions of the tissue, reimplantation is indicated. Reimplantation outcomes are better than the use of a prosthesis after amputation.
 

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Figure 12A. Amputated segment of the index finger by a mechanism of avulsion / degloving due to the use of a ring (ring finger) in 12-year-old girl.
 

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Figure 12B. Status of the index finger after degloving.
 

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Figure 12C. After reimplantation with microsurgical repair of blood vessels and nerves, the reimplanted segment retrieves the pinkish color, thus meaning revascularization. The deep flexor tendon could not be repaired due to the complexity of the injury.
 

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Figure 12D. Several years after reimplantation.
 

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Figure 12E. Several years after replantation. Although there is no distal interphalangeal flexion, the proximal interphalangeal joint enables a completely normal function.
 

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Figure 13A. 10 month child, with middle finger entrapment. A drop of the finger is observed (digital cascade loss), suggesting a section of the flexor tendons. Furthermore, the finger has lost its pinkish color, suggesting a section of the blood vessels. It requires a finger revascularization and a tendon repair.
 

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Figure 13B. Fingertip right away after revascularization. The connection of the 0.3mm vessels has restored the rosy color.

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