Replantation-Comprehensive Review –Replantation –Session IV

Video Transcription
Video Summary
In this video, the speaker discusses the topic of replantation, specifically focusing on indications, surgical technique, and post-operative care. The speaker begins by defining replantation as the reattachment of a completely severed body part, while revascularization refers to the reattachment of a partially severed body part. The speaker emphasizes the importance of considering factors such as predicted morbidity, chances of replant survival, and anticipated functional outcomes when evaluating a patient for replantation.<br /><br />The speaker then discusses various indications and contraindications for replantation. The thumb is mentioned as the best reconstructive option, while multiple digits, transmetacarpal amputations, partial hands, wrists and forearms, and individual digits distal to the FDS insertion are also considered replantable. On the other hand, severe crush injuries, amputations at multiple levels, certain single digit proximal amputations, atherosclerotic vessels, mentally unstable patients, and prolonged ischemia time are mentioned as relative contraindications to replantation.<br /><br />The speaker also provides insights into the surgical technique of replantation, including techniques for osseous shortening, fixation of bones, repair of tendons, vascular and nerve anastomosis, and skin coverage. The importance of appropriate tensioning and the use of vein grafts or conduits when necessary are also highlighted.<br /><br />Post-operative care, including pain relief, dressing, splinting, and monitoring of flaps, is discussed. The speaker mentions the use of pulse oximetry as a method to assess arterial and venous status of the replanted digit. The complications associated with replantation are also mentioned, including arterial compromise, venous outflow issues, compartment syndrome, metabolic disturbances, infections, ruptures, poor sensation, and cold intolerance.<br /><br />The speaker concludes by highlighting the demanding nature of replantation surgery and the potential for positive outcomes in cases involving thumbs, hands at the wrist, and single digits distal to the FDS insertion.
Keywords
replantation
indications
surgical technique
post-operative care
thumb
reconstructive option
complications