Which of the following statements about selection of an amputated part for replantation is/are correct?
|A||A good choice for replantation is an amputated thumb at the level of the proximal phalanx of the dominant hand of a 35-year-old salesman.|
|B||The index finger should be replanted in an adult male if the amputation is at the base of the proximal phalanx.|
|C||In a 12-year-old child with an arm amputated above the elbow by an avulsion injury, replantation should be attempted.|
|D||In a 42-year-old male accountant with a complete amputation of the leg just below the knee, replantation should be attempted.|
|E||Replantation is advisable for a 20-year-old male with a complete amputation at the proximal forearm with 11 hours of warm ischemic time.|
A good choice for replantation is an amputated thumb at the level of the proximal phalanx of the dominant hand of a 35-year-old salesman.
In a 12-year-old child with an arm amputated above the elbow by an avulsion injury, replantation should be attempted.
a. The thumb is a prime choice for replantation. If the patient is healthy replantation of the thumb is advisable at just about any level and any age.
b. Amputations of fingers proximal to the flexor superficialis tendon insertion (middle phalanx) generally result in poor active digital motion, and in most adults isolated finger amputations at this level are not replanted.
c. In general, in children replantation should be attempted at any level. Replantation of lower extremity amputations is seldom indicated in adults because of leg-length discrepancy, pain, and poor function.
d. Prosthetic replacement usually results in a more functional gait. Replantation of a forearm amputated at the proximal forearm level is difficult because of the large amount of muscle mass and the multiple nerves entering the muscle.
e. Additionally, over 6 hours of warm ischemia time at this level will most likely cause massive myonecrosis and replantation failure.