|Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.|
| The gauze and plastic prevent the tissue from coming into direct contact with the ice. This method is preferred to immersion or wrapping in a moist dressing to avoid maceration.
Apply saline-moistened sponges to wound and cover with sterile, bulky dressing. (Again, avoid extensive cleansing; this will be accomplished under anesthesia.) Splint and elevate the injured part for comfort.
IMPORTANT: Do not inject the site with local anesthesia. Local injection may cause vasoconstriction, vessel compression, or direct vessel injury.
Transportation can be arranged by the referring or receiving party. It has been an advantage at this center to employ a local medical helicopter company to dispatch air or ground transportation.
The microsurgeon at the replant center is responsible for the final transport decision, aided by the information gathered by the transport specialists. Current weather patterns, road conditions, accessibility, and convenience must all be considered. Medical considerations include the severity of the injury, the ischemia time already elapsed, and the status of amputation. Complete amputation can be cooled, whereas icing a partial amputation may decrease residual blood flow and cause undue discomfort.
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