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American Association for Hand Surgery

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Adeno-Associated Virus Vector Retrograde Transduction of Transected Murine Facial Motor Neurons
Jordan Bruce, MD1; Carrie Bettlach, FNP2; Ketan Sharma, MD3; Thomas HH Tung, MD4; Ida K Fox, MD5
1Washington University School of Medicine in St. Louis, St. Louis, MO; 2Washington University, St. Louis, MO; 3Saint Louis University, Saint Louis, MO; 4Plastic Surgery, Washington University School of Medicine, Saint Louis, MO; 5Department of Surgery, Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, MO

Introduction
The indications for pediatric digital replantation are broader than that for adults. Our group has previously shown that pediatric patients suffer many of the same complications and peri-operative challenges seen in adult replantation patients with similar rates of ultimate digit salvage. However, there are few studies of long-term patient reported outcomes in this population.

Methods
Data was collected from medical records of patients presenting to our Level 1 Trauma Pediatric Hospital Emergency Room between January 2011 and March 2017. All charts with ICD-9 codes for upper extremity trauma were queried and reviewed. Patients whose replanted digits survived to the first post-operative visit were recruited for study participation. Phone interviews of patients and family members were completed using a semi-structed interview guide.

Results
A total of 1364 patients presented with upper extremity trauma over the study period. Of these, 21 underwent replantation and 13 (62%) of these replantations survived to the first post-operative visit. Demographics included a mean age at replantation of 160 months (range 89-201), with 10 male and 3 female patients. Replantation type included 12 single-digit (2 thumbs, 2 index, 3 Long, 3 Ring, 2 Small) and one two-digit (index and long). Ten of the patients and their families participated in the study. Mean time of follow-up was 89 months post-replantation (range 74-119). Six patients reported excellent function with no limitations in schoolwork or sports. Two patients complained of severe stiffness that limited hand function in most activities. 5 patients reported cold insensitivity and 2 reported frequent pain. 4 patients had concerns about the aesthetics of their hands, and 5 continued to feel angry or unhappy about their replantation. 9 patients and 7 parents stated they would choose to again undergo replantation surgery.

Conclusions
Few patients met study criteria. The majority reported excellent function and return to normal activities. While nearly all patients would again choose to undergo replantation, many reported ongoing negative physical and psychological outcomes. Interestingly, aesthetics were more associated with long term happiness with replantation than function. Fewer parents than patients would choose to undergo replantation again. Future larger scale and comparative studies to assess incidence and the lived experience of these hand trauma patients would improve our understanding of the indications for and long-term sequelae of replantation in the pediatric population.


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