Replantation Flashcards
What are indications for replantation of amputated digit?
1) thumb at any level
2) multiple digits
3) through the palm
4) wrist level or proximal to wrist
5) almost all parts in children
Also relative:
individual digits distal to the insertion of [FDS] (Zone I)
ring avulsion
though or above elbow
What are contraindications for replantation of amputated digit
1) severe vascular disorder
2) mangled limb or crush injury
3) segmental amputation
4) prolonged ischemia time with large muscle content (>6 hours)
Also relative:
single digit proximal to FDS insertion (Zone II)
medically unstable patient
disabling psychiatric illness
tissue contamination
prolonged ischemia time with no muscle content (>12 hours)
What are warm and cold ischemia times for amputated digits/limbs?
Proximal to carpus:
Warm less than 6hrs
Cold less than 12hrs
Distal to carpus:
Warm less than 12hrs
Cold less than 24hrs
What is the general operative sequence for digit replantation?
BEAVFNS
1) Bone
2) Extensor tendon
3) Artery
4) Vein
5) Flexor tendon
6) Nerve
7) Skin
What is general post-operative care for a replantation procedure?
1) Warm room 80°F
2) Avoid caffeine, chocolate and nicotine
3) Monitor with pulse ox; less than 94% is concerning
4) Anticoagulation (heparin, ASA)
How are post-operative arterial insufficiency or venous congestion following replantation managed?
Arterial Insufficiency
treat with release constricting bandages
place extremity in dependent position
consider heparinization
consider stellate ganglion blockade
early surgical exploration if previous measures unsuccessful
thrombosis secondary to vasospasm is most common cause of early replant failure
Venous congestion
treatment
elevate extremity
leech application
releases Hirudin (powerful anticoagulant)
Aeromonos hydrophila infection can occur (prophylax with Bactrim or ciprofloxacin)
heparin soaked pledgets if leeches not available
