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Fig. 4.6. This case of pediatric multiple digit replantation from the Duke University series (References 45 and 46) illustrates the generally good results achieved when replantation is successful.

Ischemic time of an amputated part is an important consideration for replantation. Although there are no strict criteria defining maximum ischemic time for replantation, a warm ischemic time longer than 6 hours for an amputation proximal to the carpus or longer than 12 hours for the digits generally precludes consideration of replantation. It is possible to extend the ischemic time with cooling of the amputated part; however, if the cold ischemic time is longer than 12 hours for a proximal amputation, replantation is not generally performed.

Patients with severely mangled amputated parts or proximal stumps are poor candidates for replantation50 (Fig. 4.7). In certain cases in which the proximal stump is grossly contaminated, and multiple debridements or further reconstruction are required before replantation, it is possible to "park" an amputated part by temporarily coupling the arterial and venous connections in a location distal to the amputation site.51-52 Other contraindications to replantation include concomitant severe trauma or chronic illness, advanced arteriosclerotic vessel changes, and mental instability.

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