Our experiences on the replantations of zone 2 level in children

Objectives: The aim of this study is assessment of eightchildren who were operated on our clinic between 2010and 2012 for replantation or revascularization of amputationat the level of zone 2.Materials and methods: From June 2010 to February2012 eight children, aged between 3 and 15, were operatedin our department with zone 2 amputations. Typesof amputations were crash injury in 4 children and gyotintype regular amputation in 4 children. Mean ischemia timeof the amputates was 3,5 hours (range 1,5-8 hours). In 5children successful replantation were achieved but in 3children the replantation was failed because of insufficientcirculation despite recurrent anastomosis. Papaverin wasused preoperatively in all cases. Mean follow-up periodwas 9 months (range 2-16 months).Results: Local administration of papaverin facilitates thereplantation with promoting vasodilatation meaningfully.In addition, solutions used preoperatively such as lidocain,heparin, warm irrigation solutions (mean 28°C 0,9%NaCl) and also postoperatively administration of low molecularweight dextran and heparin, acetyl salicylic acid,pentoxyphyllin increase the success rate of replantation.Another important factor is also short of mean ischemiatime.Conclusion: Some tools and methods are essential formanagement of the replantation at zone 2 in pediatricssuch as, a good magnification, sensitive microsurgeryequipment, 10/0-11/0 micro-sutures, effective vasodilatationper-operatively, adequate bone shortening and surgicalexploration and close follow-up postoperatively. Postoperativerehabilitation is also an obligation to increasethe success of the replantation.