This technique aims to prioritize the replantation of fingers that are functionally more important, in cases of amputation of two or more fingers.7 Moreover, http://www.selleckchem.com/products/SB-203580.html it sometimes allows us to associate the shortening technique, technically facilitating the replantation procedure. As already discussed, in avulsion injuries, especially of large segments, we often come across associated loss of skin cover. Many cases can be resolved with a simple partial skin graft, yet some more complex cases require coverage with microsurgical flaps.29 Ideally the skin coverage should be performed in conjunction with the replantation procedure, but it is necessary to weigh the patient’s clinical state and the prolonged surgical time. (Figures 3 to 12) Figure 3 Male patient, aged 32 years.

Avulsion of left thumb caused by lawn mower 4 hours ago. Surgical technique: Transposition of the ulnar artery of the left 3rd digit Left thumb. Figure 4 Male patient, aged 28 years. Amputation left 1st, 2nd and 3rd digits by paper cutter (guillotine + avulsion) 6 hours ago. Surgical technique: Heterotopic replantation of the 3rd digit in the left thumb. Figure 5 Male patient, aged 7 years. Degloving injury left hand with avulsion of the left thumb 2 hours ago caused by industrial machine (bakery). Surgical technique: Dorsalis pedis vein graft for anastomosis between radial artery (anatomical snuffbox) and princeps … Figure 6 Male patient, aged 46 years. Avulsion of left thumb caused by motorcycle chain 5 hours ago. Surgical technique: Stump shortening with primary anastomosis of the vessels and nerves.

Interphalangeal arthrodesis of the thumb. Figure 7 Male patient, aged 33 years. Avulsion of the right arm 3 hours ago after motorcycle accident. Surgical technique: humeral shortening, vascular grafts (great saphenous vein) for artery reconstruction and brachial vein, sural nerve graft for reconstruction … Figure 8 Male patient, aged 24 years. Avulsion of the right forearm 5 hours ago, caused by industrial machine. Surgical technique: forearm shortening; vascular grafts (great saphenous vein) for reconstruction of radial and ulnar arteries and cephalic and basilic … Figure 9 Female patient, aged 29 years. Avulsion of right 4th digit by ring hours ago. Surgical technique: Vascular grafts (veins from palmar system of wrist) for arteries reconstruction and digital veins; Suture of the digital nerves.

Figure 10 Male patient, aged 17 years. Bilateral avulsion of the feet caused by a crane 8 hours ago. Surgical technique: bone shortening; vascular grafts (great saphenous vein of the leg not replanted) for reconstruction of the anterior and posterior tibial arteries … Figure 11 Male patient, aged 32 years. Avulsion of the right thumb Brefeldin_A caused by motor belt 4 hours ago. Surgical technique: transfer of radial digital artery of the middle finger to princeps pollicis artery of the thumb, vein grafts to dorsal veins. Radial sensory …