Replantation of large segments in children.

If one looks at the final results obtained in children, one should conclude that replantation of large segments is more often indicated in children than in adult patients. Nevertheless, the more common components of crush or avulsion and the frequent severe associated lesions must restrain the surgeon's enthusiasm when indicating replantation of a large segment in children. The possible dramatic consequences of a late revascularization syndrome can be easily foreseen as an outcome of replantation of a large segment in children. Moreover, the problem of growth must be faced from the start, programming secondary surgery either for soft tissue assessment (skin retraction treatments, tendon lengthening, muscle sliding) or for bone lengthening. The final outcome being a functional arm, special care has to be taken in nerve repair integrated with possible secondary tendon transfers to compensate the functional deficit. With all these limitations in indications, care in emergency, and correct timing and planning for secondary surgery, the final functional results of macroreplantations in children will certainly be improved.