[size=20px]An eight-year-old boy suffered an amputation of his thumb, index and long finger while playing with a circular saw. The digits arrive with the patient. In order to improve the success of replantation, the digits should be placed

 

A in a sealed bag in a warm saline solution

 

B directly in an ice water solution.

 

C in saline soaked gauze, in a sealed bag, in iced saline.

 

D in saline soaked gauze, in a sealed bag, in a container of dry ice.[/size]

D

C

D

D

C

D

D

D

D

C

Correct answer

C in saline soaked gauze, in a sealed bag, in iced saline.

 

Preservation of the amputated digit is key to successful replantation. Most experts agree that 12 hours of warm and 24 hours of cold ischemia are reliable times for prediction of successful replantation of digits. For major upper extremity replantation, the general agreement regarding reliable ischemia times for successful replantation are 6 hours of warm and 12 hours of cold ischemia. The amputated part should be immersed in saline solution or wrapped in a saline-moistened gauze immediately, placed in a sealed plastic bag, and submerged in ice saline solution (approximately at 4°C). Minimizing warm ischemia is critical. Immersing the severed part directly into water or freezing the part should be avoided. Reports of successful digit replantation after 94 hours of cold and 33 hours of warm ischemia have been published in the literature, but should only be attempted in selected cases.

 

On arrival at the replantation center, the severed part should be taken to the operating room immediately to be examine, prepared for replantation, and stored at 4 °C until time for revascularization.

C