Replantation with Dr. Greg Buncke and Dr. James Urbaniak

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Topics Covered:

  • What are your true indications for replantation (aside from what is published?)
  • How distal will you attempt replantation? 
  • What instruments are important to have in the operating room when you perform a replantation?
  • Intraoperative details
    • How long does a replant take?
    • What is your order of repair?
    • What technique do you find best for bony fixation? Tendon repair?
    • How many veins do you typically anastomose? Will you anastomose a vein with a skin bridge? 
    • How often do you vein graft in a replantation? What are some indications for vein grafting? 
  • Do you recommend a flap at the time of replantation? Venous flaps?
  • Ring Avulsion Injuries: Should Type III avulsions be discarded?
  • Post-operative protocol?
    • Do you heparinize? Leeches?
    • When do patients start occupational therapy?
  • Who does poorly after replantation?
  • What are some options besides replantation for thumb reconstruction?
  • Do you need a thumb vs toe to thumb replantation? 
  • When consenting for a toe to thumb what kind of conversation do you have with the patient?
  • What have been some innovations in replantation?
  • How have attitudes changed towards replantation?

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