Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.
  Table of Contents / Chapter 33:
Secondary Reconstruction After Replantation
  In some cases, primary and secondary variables are all in the patient's favor and the functional result is extraordinary. These can be predicted in certain instances such as a clean, sharp amputation distal to the sublimis of one or several fingers.2,21,27,34 A similar case, however, may end in a functional disaster if infection sets in, ischemia time is prolonged, the revascularization is marginal, or the postoperative therapy is unavailable or inexperienced.2,6 Although many studies have attempted to define prognostic factors in replantation,1,2,7-10,14,15,35,36 the influence of individual primary and secondary variables remains difficult to predict. The permutations and combinations of these variables are so numerous that one must be diligent in efforts to evaluate, control, and modify the reconstructive plan, applying realistic goals and including the patient's needs whenever possible. Secondary efforts may well be fruitless with a crushing injury at a proximal level compounded by prolonged ischemia time, delayed healing, and massive scar tissue contractures. Reamputation, though seldom reported,6,14,21 may be the logical choice rather than reoperation with further disability and deformity.6 In special cases, the imaginative use of multiple microvascular transplants may result in improved vascular supply to distal tissues and the replacement of frozen digits with supple transplants placed on a foundation provided by the "failed replant." 37,38

  Secondary Tendon Operations

Table 33-1  Secondary Procedures in Digital Replants.

Table 33-2  Types of Secondary Procedures.

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