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Flashcards in Replantation Deck (15):
1

What are the indications to reimplantaiton?

Thumb
multiple digits
almost all parts for children
wrist to forearm
elbow and above elbow
individual digits distal to insertion of FDS

2

What are the contraindications to reimplantation?

SINGLE DIGIT PROXIMAL TO FDS INSERTION -ZONE II- poor results due to loss of pipj motion due to flexor sheath adhesion
Mangled part- difficulty healing, infection->poor oc
multiple levels
other serious medical conditions
prolonged ischaemic time
self inflicted wounds
mentally unstable pt

3

How is the amputated tissue transported

Keep moist in gauze with lactate ringers solution
place in sealed plastic bag then ice at 4oC

4

What is the time to reimplantation
Proximal to carpus?

Warm ischaemic time 12 hours

5

What is the time to reimplantation
distal to carpus?

warm ischaemic time <24 hours

6

what is the sequence of structures you reimplant?

BEFANVS Be famous in funny accent!!

Bone
Extensor tendons
Flexor tendons
Arteries
Nerves
Veins
Skin

7

What order are fingers reimplanated?

Thumb
Long
Ring
Small
Index

8

For multiple amputations what sequence is most effective?

Structure by structure

9

For multiple amputations what sequence takes the longest?

Digit by digit

10

What would your post care be?

Keep pt in warm room 80oF
Avoid caffeine, chocolate and nicotine

Implant- pulse oximetry 2 degrees within the hour post op or a temp below 30oC

Anticoagulant- adequate hydration
meds- LMWH

11

How do you tx arterial insufficiency?

Restrict bandages
place extremity in dependent position
? heparinisation
Stellate ganglion block
early surgical exploration if non work
thrombosis secondary to vasospam is most common cause of early reimplant failure

12

How do you tx venous insufficiency?

elevate extremity
Leech application- release Hirudin - anticoagulant or heparin soaked pledgets

13

What are the complications of reimplanation?

Infection
cold intolerance
stiffness
myoglobinuria- muscle necrosis in larger implants-> renal implants and fatal
reperfusion injury- thought to be sue to mechanism of ischaemic induced hypoxanthine to xanthine- allopurinol best adjunct

14

When does arterial insufficiency occur?

Within 12 hours post op

15

When does venous insufficiency occur?

After 12 hours post op