Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.
  Table of Contents / Chapter 31:
Replantation Surgery
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  A suspected arterial insufficiency, accompanied by vasospasm, that does not resolve within several minutes after nonoperative treatment must be explored and the anastomosis redone, usually with a vein graft. Look for technical problems such as vessel compression, kinking, twisting, or unsatisfied side branches. Possible, too, is a thrombus in a previously unrecognized injured segment of the vessel. These vessels should be resected and vein grafts inserted. When vascular problems occur more than 2 or 3 days after replantation, the digit can seldom be salvaged.

NO-CODE REPLANTS

There are instances in which parts have been replanted under extremely difficult conditions and salvage by any additional surgery is unlikely. Maximum effort has been expended, and one must await the outcome, using every supportive measure. The patient and treating personnel should be advised that everything has been done and that reoperation is impossible if the part fails. Such a replant should not be subjected to the demanding monitoring and inspection regimes that are taxing to both patient and staff.

Clinical Cases

CASE 1

A patient had an avulsive injury of the thumb.

  FIG. 31-01. Zone I injuries usually do well following replantation. The avulsive nature of this thumb injury, however, required vein grafting to the distal artery to restore circulation.


FIG. 31-02. After replantation, venous congestion developed. The nail has been totally removed to allow application of heparin sponges on the nail bed to relieve the congestion.


FIG. 31-03. Late follow-up shows excellent functional result.


FIG. 31-04. Normal nail growth has recurred.


CASE 2

A patient suffered severe finger injures in the right hand.

FIG. 31-05. Three-fingertip amputations at the DIP level.


FIG. 31-06. The index finger-tip has been replanted. All three PIP joints were fused at 20 to 30 degrees of flexion.


FIG. 31-07. Postoperative result shows excellent extension with no compromise of PIP joint function.


FIG. 31-08. Flexion.


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