Chapter 36 - Replantations in the Upper Extremities

Question 1

absolute indications for replantations

Answer 1

1. thumb at ANY level
2. multiple digits
3. through the palm
4. wrist or forearm level (below the elbow)
5. ANY amputation in a child

Question 2

relative indications for replants

Answer 2

1. individual digits distal to the FDS insertion
2. ring avulsions
3. through or above the level of the elbow

Question 3

absolute CONTRAindications for replant

Answer 3

1. severely mangled
2. patients with severe systemic disease
3. severe vascular disease
4. prolonged (>6hr with large muscular content) warm ischemia time

Question 4

relative CONTRAindications for replant

Answer 4

1. border digits (esp proximal to fds insertion)
2. multilevel amputations (eg digit in multiple pieces)
3. avulsion injuries
4. prolonged warm ischemia time (>12 hours if little to no muscular content)

Question 5

the best functional replants occur at what level?

Answer 5

distal forearm

Question 6

why is bone shortening often necessary in replants?

Answer 6

to promote end to end anastamosis of the vasculature

Question 7

general order of replant of a digit

Answer 7

BEFAVN

0. debride
1. bone
2. extensor tendon
3. flexor tendon
4. digital artery (one vessel at first)
5. vein
6. nerve last - most delicate repair, can even come back if need to - eg too much or time, but cant leave without vessels done

Question 8

what percent of hand function can you expect to lose if you do not replant a thumb?

Answer 8

50%

Question 9

what digital a is preferred in thumb replant

Answer 9

ulnar digital a