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Hand Digit Revascularization: Could Be an "Elective-Urgence" Surgery?

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Delayed finger replantation is feasible even after 72 hours of warm ischemia. This case study challenges traditional time limits, suggesting improved protocols could increase access to this limb-saving surgery.

Keywords:
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Area of Science:

  • Microsurgery
  • Reconstructive Surgery
  • Trauma Surgery

Background:

  • Timeliness is a major barrier to finger replantation due to traditional beliefs about ischemia time limits.
  • Established ischemia time limits (6h warm, 12h cold) are largely theoretical.
  • Current protocols often necessitate costly emergency procedures, limiting access.

Purpose of the Study:

  • To present a case of successful multi-digit revascularization after prolonged warm ischemia.
  • To challenge existing literature regarding critical ischemia time for finger viability.
  • To advocate for evidence-based protocol changes in finger replantation.

Main Methods:

  • Microsurgical arteriovenous bypass technique utilized for revascularization.
  • Case study of multi-digit revascularization after 72 hours of warm ischemia.
  • Assessment of motor and sensory function recovery post-replantation.

Main Results:

  • Successful revascularization achieved after 72 hours of warm ischemia.
  • Good recovery of both motor and sensory function observed.
  • Demonstrated feasibility of delayed finger replantation beyond traditional limits.

Conclusions:

  • Significant limitations exist in literature supporting strict ischemia time limits for finger replantation.
  • Recent evidence supports the feasibility of delayed finger replantation.
  • Revising protocols based on evidence can expand access and improve care for amputation injuries.