Abstract book - ESPRAS

More documents

Recommendations

Info

As regard the level of amputation, scapulothoracic amputation with brachial plexus root avulsions represented the only real absolute contra-indication to replantation. Amputations through the arm to the wrist have the potential for recovery of useful functions, and should be attempted in selected cases after careful evaluation. The same evaluation and case selection is recommended for single digit and distal digital amputations. There is general agreement on the absolute indication for replantation of the thumb, mid-palm, wrist, and forearm level in children so long as the part is not severely crushed. Microsurgical repair of the tiny vessels of infants makes the operation technically difficult; on the other hand, functional return after replantation of digits in small children is often quite good. In the elderly, useful functional recovery cannot be expected with any reliability, thus any attempt at replantation in elderly patients should be carefully weighed against the potential systemic insult from the anesthesia and operation. Clean, minimally crushed amputations yield the best results after replantation. Avulsion injuries, severely contaminated wounds, and amputations with multiple levels of injury are poor choices for replantation. Microsurgical repair in cases where the entire finger has been degloved does not result in good function. Kleinert vi believes that 12 hours or more of warm ischemia is a relative contraindication to digital replantation. Prompt cooling of the amputated digit to 4°C prolongs the acceptable ischemic period to over 24 hours, with a good chance of complete survival and full functional return. Regarding the patient selection, his/her occupation, economic and social status, nationality, mental health and cooperativeness must all be taken into account when deciding whether to attempt replantation or not. When performing a replantation, one must be particularly careful to place the anastomoses outside the zone of injury and to incorporate only undamaged vessel ends. Excessive shortening of replanted parts results in muscle-tendon imbalance and dysfunction. The operative sequence varies according to the clinical situation and surgeon's preference. A common approach involves the following steps: - preoperative patient evaluation and preparation - identification of structures in amputated part - identification of structures in the amputation stump - bone shortening (minimal) and bony fixation - muscle-tendon unit repair - nerve repair - arterial repair (with or without recirculation) - venous repair - skin closure or soft tissue coverage There are as many different standards for evaluating functional recovery after replantation (for sensation, motor outcomes, assessment to cold intolerance and all the indicators of complications) as there are reporting surgeons vii . For failed replants or for extremities that cannot be replanted at the time of injury, function can be partially restored by toe-to-finger or toe-to-thumb transplant. Leung viii and Frykman ix describe the technique and functional results of these transfers. Transplantation of composite tissue allografts, such as a hand, offers immense potential in reconstructive surgery. Thus far, six human hand transplants have been performed with various degrees of success. A
eview of current replantation literature suggests that the prospect for significant functional return following a hand transplant is quite good so long as here is judicious patient selection and prevention of allograft rejection x . REFERENCES 1 Mc Carthy: Replantation and revascularization of the upper extremity. Plastic Surgery, Vol.7, The hand, Part 1, May & Littler 1990, p.4356. 1 Meyer VE, Chen Z-W, Beasley RW: Basic technical considerations in reattachment surgery. Orthop Clin North Am 12:871, 1981. 1 Chow JA et al: Forearm replantation — Long term functional results. Ann Plast Surg 10:15, 1983. 1 Russell RC et al: The late functional results of upper limb revascularization and replantation. J Hand Surg 9A:623, 1984. 1 Urbaniak JR: Replantation of amputated parts: Technique, results, and indications. In: AAOS Symposium on Microsurgery. St Louis, CV Mosby, 1979, pp 64-82. 1 Kleinert H, Jablon M, Tsai T: An overview of replantation and results of 347 replants in 245 patients. J Trauma 20:390, 1980. 1 Tamai S: Twenty years' experience of limb replantation: Review of 293 upper extremity replants. J Hand Surg, 7:549, 1982. 1 Leung PC: Thumb reconstruction using second-toe transfer. Hand Clin 1(2):285, 1985. 1 Frykman GK et al: Functional evaluation of the hand and foot after one-stage toe-to-hand transfer. J Hand Surg 11A:9, 1986. 1 Lee WP, Mathes DW: Hand transplantation: pertinent data and future outlook. J Hand Surg 24A(5):906, 1999.
Page 1 and 2: Croatian Medical Association Croati
Page 3 and 4: 5th CROATIAN CONGRESS FOR PLASTIC,
Page 5 and 6: ORGANIZING COMMITTEE CONGRESS PRESI
Page 7 and 8: CONTENTS Lectures 1 SESSION A : Hea
Page 9 and 10: LECTURES
Page 11 and 12: L1. Craniofacial deformity Prof. Ia
Page 13 and 14: Lateral videofluoroscopy most usefu
Page 15: L11. Replantation Prof. Aurelio Por

Abstract book - ESPRAS

Create successful ePaper yourself

Delete template?

Save as template?