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Case 28: Circular saw injury

A 73 year old man presented after an accident in his home workshop.

1. What are the most important factors when considering a finger replant ?

Which injuries require replantation:
all thumb amputations
multiple amputated digits
all children
all amputations proximal to the digits
single digits proximal to the FDS insertion

Strong contraindications:
significant associated injuries to the torso and head.
extensive injury to the affected limb or to amputated part (degloving, widespread crush)
severe chronic illness precluding transportation or prolonged surgery

Relative contraindications:
Single digit amputation, esp distal to insertion of FDP
avulsion injuries
severe degloving injuries
previous injury or surgery to the part
extreme contamination
lengthy warm ischaemia >8hrs (at 4 degrees C >30 hrs)
poor rehabilitation potential

Powerpoint presentation - Assessment and management of hand injuries