Replantation

Chapter 8 of Volume 1, Hand & Upper Limb. Revision notes and examiner-style viva questions with model answers for the FRCS (Plast).

26 viva questions in this chapter

1. This man has amputated his index finger through the middle phalanx. Would you replant it?
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2. What are the indications for replantation?
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3. How would you assess this patient?
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4. How should the amputated part be transported?
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5. How would you classify this fingertip amputation?
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6. This is a ring avulsion injury. How do you classify it?
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7. How would you grade the functional outcome of a major limb replant?
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8. Take me through the replantation.
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9. This is a Tamai zone I amputation with no repairable vein. What now?
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10. The thumb has been amputated at the level of the proximal phalanx. What are you going to do?
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11. All four fingers are amputated. Where do you start?
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12. The amputation is through the midcarpus. Talk me through it.
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13. This patient has a transhumeral amputation. Would you replant it?
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14. Take me through the macroreplantation.
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15. What is your post-operative protocol?
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16. How do you tell an arterial problem from a venous one?
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17. How long do you monitor, and when do they fail?
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18. The digit is congested at six hours. What do you do?
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19. What anticoagulation would you use?
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20. What is the no-reflow phenomenon?
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21. You go back to theatre and the anastomosis is patent but the digit is dead-looking. Would you thrombolyse?
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22. What would you tell this patient to expect?
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23. What secondary surgery will they need, and when?
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24. Should this operation be done in your unit at all?
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25. This is a four-year-old with an amputated fingertip. Does that change anything?
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26. What is the difference between replantation and revascularisation?
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