Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.
  Table of Contents / Chapter 30:
Transportation Protocol
  Successful replantation and return of function of traumatically amputated parts depends on an organized team approach. The replant center must be staffed with enough experienced surgical teams to provide 24-hour service, anticipate concurrent cases, and relieve the operating surgeons during long procedures. A prepared emergency staff must be able to direct the referring emergency room staff and transport team in a safe and expedient transfer to the replant center. Twentyfour-hour coverage by anesthesia and operating room personnel must be available. Multiple operating suites must be set up with the proper microscopes, instruments, and sutures.

A carefully trained nursing staff is necessary to render postoperative care and monitoring. Occupational and physical therapists familiar with the unique needs of postreplantation rehabilitation play a major role in the functional recovery of the patient. Social workers and psychologists round out the team and are a necessary adjunct to the nursing staff to help each patient adjust to his or her injury and rehabilitation.

The initial responsibilities of the referring emergency room physician and staff are to stabilize the patient, confirm that no coexisting life-threatening injuries exist, and prepare the patient and amputated part for transport to the replant center.


Early telephone contact with the microsurgeon by the referring emergency room physician increases the chance for successful replantation. Specific information must be clearly conveyed.

The following questions must be answered. What time did the injury occur, and at what point was the part cooled? What type of injury caused the amputation? For example, is it a crush, avulsion, degloving, or guillotine injury? Is the amputation complete? If not, are there signs of circulation or sensation? At what level has the injury occurred? Which hand or limb is injured, and were there any previous injuries to the affected part? Does the patient have any other injuries? Does he or she have any other illnesses? Time is of the essence in these cases, and familiarity with this list of questions and the following protocol can assure rapid, effective primary care.

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