Efficiency in Replantation/Revascularization Surgery - 29/03/19

Doi : 10.1016/j.hcl.2018.12.004

Bauback Safa, MD, MBA ^a,^⁎ , Mark A. Greyson, MD ^b, Kyle R. Eberlin, MD ^b
^a The Buncke Clinic, 45 Castro Street, Suite 121, San Francisco, CA 94114, USA
^b Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, WAC 435, Boston, MA 02114, USA

^∗Corresponding author.

Resumen

Digital replantation and revascularization have evolved significantly since the first published reports in the 1960s. Advances in techniques and instruments have made these once formidable procedures a routine part of hand surgery training. Despite this, the frequency of successful outcomes for replantation may be on the decline in the United States. This review summarizes key mechanisms and innovations used to maximize efficiency when presented with a digital replantation, from the moment the patient arrives in the emergency department until the time of discharge.

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Keywords : Replant, Digital, Efficiency, Revascularization, Microvascular, Technique, Reconstruction

Esquema

Key points

Introduction

Preparation for replantation

Patient arrival to the emergency department

Operative intervention

Osteosynthesis

Extensor Tendon Repair

Flexor Tendon Repair

Arterial Repair/Reconstruction

Nerve Repair/Reconstruction

Palmar Skin Closure

Venous Repair/Reconstruction

Special circumstances

Vein First Replantation/Revascularization

Distal Replantation

Efficiency in postoperative rehabilitation

Top 10 replantation pearls and pitfalls

	Disclosure Statement: The authors did not receive any funding for this study. Dr B. Safa is a consultant for AxoGen. Dr K.R. Eberlin is a consultant for AxoGen and Integra.
	Level of Evidence: Expert Opinion V.