Postoperative Care

Postoperative management of the replantation patient is critical in achieving success. Postoperatively, the patient should be protected from vasospasm, pain, anxiety, tobacco smoke, cold temperatures, and caffeine, which can contribute to vasospasm during the first two weeks after surgery.62-63 The patients room is kept above 21°C (70°F) The hand is placed on a soft pile of blankets or in a foam cradle at heart level. If arterial inflow is a concern, then the hand is lowered. If venous engorgement is present, the hand can be elevated.

I routinely use some form of systemic anticoagulation. Most commonly, I employ a combination of aspirin 325 mg per day and intravenous heparin, adjusting the heparin to increase the partial thromboplastin time to 1.5 times control for 5-7 days. Care must be taken not to anticoagulate patients to the point of bleeding complications. For more proximal major limb replantations heparinization is not routinely carried out and Dextran 40 (500 cc per day ) is given instead.

Fig. 4.11. Revascularization in major limb injury starts with placement of an arterial shunt to limit ischemia time and myonecrosis.

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How To Win Your War Against Anxiety Disorders

How To Win Your War Against Anxiety Disorders

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