HS09 REPLANTATION SURGERY – THE RECONSTRUCTIVE APPROACH

The function of the replanted parts can be improved if attention to reconstruction techniques is carried out. These reconstructive techniques are: 1) adequate debridement and shortening, 2) stable skeletal fixation, 3) strengthened tendon repairs, 4) quality nerve repair, 5) extensive vascular anastomosis, 6) complete skin coverable, and 7) Early intensive active rehabilitation. 1)  The debridement should be generous and the shortening judicious. More than 50% of the skin should be in direct contact, and direct anastomosis of some of vessels should be possible. 2)  The skeletal stabilization should be of good very quality that will allow free mobilization of the joints. 3)  The repair of the tendons should take advantage of the excess length for a strengthen repair. Some degree of active mobilization should be make possible. 4)  Primary nerve grafting or nerve transfer should be considered if there is loss of nerve length. 5)  Vascular repair should be on the basis of as many as possible the number of arteries and veins that can be found for anastomosis. 6)  Any residual skin defect should be planned for a proper resurfacing within the next 5 to 10 days. 7)  Early intensive active rehabilitation should be prescribed. Gradual active ROM for tendon gliding should be instituted with in the first week. The function of the replanted digit and hand has continued to improve with the reconstructive approach. With further experience the reconstructive approach can be done in all cases with confidence.