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primary indications
multiple digits
relative indications
individual digits distal to the insertion of flexor digitorum superficialis [FDS] (Zone I)
ring avulsion
Contraindications to replantation
o
primary contraindications
segmental amputation
relative contraindications
tissue contamination
Treatment
Transport of amputated tissue
o
indications
modality
place in sealed plastic bag and place in ice water (avoid direct ice or dry ice)
Operative
o
time to replantation
bone fixation +/- shortening (after irrigation and debridement of soft-tissue and bone)
11
11
11
venous anastomoses
11
11
nerve repair
11
finger order
proximal to carpus
Postoperative Care
Environment
Replant monitoring
o
pulse oximetry
Anticoagulation
o
adequate hydration
Arterial Insufficiency
o
concerning changes include a > 2 drop in skin temp in less than one hour or a temperature
treat with
consider heparinization
Venous congestion
o
treatment
elevate extremity
leech application
Complications
Replantation failure
o
Stiffness
o
Myonecrosis
o
most frequently cause within 12 hours is arterial thrombosis from persistent vasospasm
Myoglobinuria
o
Reperfusion injury
o
Infection
Cold intolerance
segmental amputasi
berkepanjangan waktu iskemia dengan konten otot besar (> 6 jam)
o kontraindikasi relatif
satu digit proksimal ke FDS penyisipan (Zona II)
pasien medis tidak stabil
menonaktifkan penyakit jiwa
kontaminasi jaringan
waktu iskemia yang berkepanjangan tanpa konten otot (> 12 jam)