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Replantation & Microsurgery

Amputation defined by the anatomical site

Can be guillotine, crush or avulsion (these have the poorest results and prognosis)

Care of the amputated part

Gently irrigate with Hartmann's

Wrap in wet swab

Place in bag and place bag in ice

Ischaemia time

 

Warm ischaemia time

Cool ischaemia time (4°c)

Digit

12 hours

24 hours

Significant amount of muscle

6 hours

12 hours

Indications for Replantation

  1. Thumb amputation
  2. Multiple digit amputations
  3. Metacarpal amputation
  4. Almost any body part in a child
  5. Wrist or forearm amputation
  6. Individual digit distal to FDS insertion, replantation at level distal to insertion of FDS often results in satisfactory function [Diagram]

Shaded area = 'No mans land' - also region where replantation does badly



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