The use of a tablet computer for young children undergoing wide awake surgical procedures in the hand

Abstract

distal replantations, an advancement flap and eventually a repositioning of the amputated bone is indicated. This procedure seems to give nearly similar results as replantation, but it is less expensive and quicker. Recovery is also faster for advancement flaps. Replantation requires a longer period of sensory reeducation (Shieh et al., 1995), which has an important influence on the final sensory recovery. We do not have strong evidence to support our personal clinical experience with very distal finger replantation, but one report and one systematic review supporting our surgical rationale are present in the literature. Hattori et al. (2006) compared functional outcomes after successful replantation vs amputation closure for single fingertip amputations and concluded that replantation gives minimal pain, better functional outcome, better appearance, and higher patient satisfaction compared with terminalization and flap coverage. In a systematic review on fingertip replantation, Sebastin and Chung (2011) found a high incidence of success and good functional outcome following distal digital replantation. We feel there is a lack of strong evidence such as randomized controlled trials, but we also believe it is highly difficult to conduct a well-designed randomized prospective study for this type of procedure. There are many reports from Eastern world surgeons, who are highly skilled and trained in microsurgical techniques. Comparisons of outcomes can be biased if the patients of very competent microsurgeons are compared with those treated by less competent microsurgeons.