20230519 Quiz Replantation

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

A patient presents with a hand injury after an accidental self-inflicted gunshot wound. The ring finger is traumatically amputated at the proximal phalanx. Which treatment option will provide optimal cosmesis and grip strength?

• Early revision amputation

• Early replantation

• Delayed fourth ray resection

• Early fourth ray resection with fifth ray transposition

• Delayed fourth ray resection with fifth ray transposition

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

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 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