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A 34-year-old male undergoes a thumb replantation after an industrial meat slicer accident. At 4 hours postoperatively there is a drop from 33 degrees Celsius to 29 degrees Celsius and the pulse oximetry monitor on the thumb reads 87%. All of the following are treatment options for the management of his arterial inflow insufficiency EXCEPT:
Administer IV heparin
Administer a stellate ganglion block
Placement of leeches on the thumb
Inspect the dressing for any constriction
Place the thumb in a dependent position.
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A 42-year-old male sustains the injury seen in Figure A. Which of the following is true regarding management of this injury?
Replantation at this level has a worse functional outcome when compared to above the elbow amputations
The veins should be reconstructed prior to the arteries
Bony stabilization should occur at the end of the procedure
Vein grafting should not be used at this level of amputation
A warm ischemia time of 8 hours is a relative contraindication to replantation
A 30-year-old healthy female sustains a traumatic digit amputation while working at a factory. Which of the following is a absolute indication for digit replantation in this patient?
Isolated amputation of the index finger proximal to the FDS insertion
Amputation due to crush injury
Replantation of an index finger with a segmental injury
Isolated amputation of the thumb proximal to the FPL insertion
Presentation 13 hours after the amputation occurred
Ischemia induced by the conversion of hypoxanthine to xanthine is thought to be involved in the mechanism of reperfusion injury following restoration of circulation after replantation. Which of the following agents inhibits conversion to xanthine and has been shown to improve outcomes following digit replantation?
Tissue plasminogen activator
COX 2 inhibitor
Which of the following amputations may be considered a relative contraindication for a replantation?
Ring finger through the proximal phalanx shaft
Thumb through the proximal phalanx
Middle, ring, and small fingers through the middle phalanx shaft
Complete hand just proximal to the distal palmar crease
What is the most important factor influencing immediate and late outcome of digit replantation?
Anastamosing the proximal profundus tendon stump to the superficialis tendon of the amputated digit
Regular cigarette smoking
Utilization of composite skin and subcutaneous vein graft
Mechanism of digit amputation injury
Each of the following are indications for microvascular replantation EXCEPT?
Index finger amputation in a child
Through wrist amputation
Long finger amputation through the proximal phalanx
Mid-palm amputation of all four fingers
A 25-year-old right-hand dominant construction worker suffers an industrial injury as seen below. He is hemodynamically stable and his only injury is to the limb below. In terms of replantation of the affected limb, which of the following is true?
Transpositional microsurgery offers the best results
Replantation is contraindicated as the injury is through flexor zone II
Replantation is contraindicated because of the extent of injury
Heterotopic transplantation would offer the best function
Anatomic replantation of hand offers the best results
A 34-year-old male sustains amputations of the 4th and 5th fingers at the level of the middle phalanx after cutting them with a butcher knife. Which of the following techniques would most likely increase total surgical time during replantation?
Utilizing an on-call surgical team experienced at digit replantations
Digit-by-digit repair method
Structure-by-structure repair method
Bone shortening procedures to avoid the need for vein grafts
Obtaining a thorough inventory of the digit structures that are deficient and the structures that are available for reconstruction
Replantation is indicated for which of the following amputations.
multiple level amputation of the small finger at the proximal and distal interphalangeal joints
crushed amputation through the distal phalanx of the middle finger
complete ring avulsion of the ring finger with tendon injury
thumb amputation though the proximal phalanx shaft
middle finger amputation though the proximal phalanx shaft
All of the following factors are favorable for digit survival after replantation surgery EXCEPT?
Sharply amputated digit
Crushed amputated digit
Warm ischemia time of 8 hours
Patient age of 10 years