T h e successful replantation of a thumb in a 7-month-old girl was recently performed. A review of the literature revealed that this has been the youngest replant performed using microvascular techniques. We present this case to discuss our techniques as well as to review the literature on pediatric replantation.
CASE REPORT
At approximately 9:oO PM on the night of admission, L.M., a 7-month, 3-week-old girl, had her right thumb amputated with a pair of shears. The child was brought to a refemng hospital without the amputated part; after the mother retrieved the thumb from home, it was placed in saline in a sterile cup on an ice slurry and both the part and the patient were transferred to Duke University Medical Center.
Examination in the emergency mom revealed that the thumb had been cleanly amputated through the interphalangeal joint; the child was in excellent health, and it was felt that attempted replantation was indicated (Fig. 1). The amputated thumb was taken immediately to the operating room where it was cleaned and prepared for surgery; the arteries, veins, nerves, and tendons were identified and tagged for replantation, and the thumb was cooled on a sterile ice tray.
After preoperative antibiotics, replantation was performed under general anesthesia starting at 2:45 AM and ending at approximately 7:oO AM. The actual revascularization was performed at approximately 5:OO AM, resulting in an estimated cold ischemia time of 8 hours. First, bony