Non-microsurgical replantation (composite graft with palmar pocketing) – a case report of successful reintegration of distal finger amputation

Microvascular replantation in not always feasible for distal finger amputations. Our work presents a case of 23-year-old woman who suffered an amputation of index finger at the level of nail base. She was disqualified from microvascular replantation, however, the cooperation with Replantation Service resulted in an uncommon method of treatment, which resulted in excellent functional and aesthetic outcome. Composite grafting for fingertip amputations is a unique procedure which enables preserving original tissue with its function. We consider composite grafting to be a valuable adjunct to the wide range of methods for treating distal finger amputiations.

Successful replantation of amputated penis with adjuvant hyperbaric oxygen therapy

Successful penile replantations are rarely reported in the literature and are associated with significant complications. We present a case of a patient who auto-amputated his penis. Delayed microvascular replantation was performed approximately 14 hours following injury. He was treated with a phosphodiesterase inhibitor postoperatively, and adjuvant hyperbaric oxygen (HBO2) therapy was started 58 hours after replantation; 20 treatments at 2.4 atmospheres absolute (ATA), twice daily for eight days, followed by once daily for four days. Perfusion of the replanted penis was serially assessed using fluorescent angiography. With some additional surgical procedures including a split- thickness skin graft to the shaft due to skin necrosis he has made a complete recovery with return of normal urinary and sexual function. This unusual case illustrates the potential benefit of HBO2 therapy in preserving viability of a severed body part. Fluorescent angiography may have potential utility in monitoring efficacy of HBO2.

Attempted Nose and Lip Replantation after Partial Animal Digestion

We report a case of a 71-year-old female patient who sustained a severe midface soft tissue avulsion injury from a family canine. The removed tissue was recovered from the canine's digestive tract and transferred to the hospital where emergent microvascular replantation was performed. The tissue survived for 72 hours, but then developed vascular compromise. Despite aggressive revision of multiple anastomoses with extensive use of vein grafting, the replanted segment was lost. Reconstruction then proceeded along traditional lines with an acceptable cosmetic outcome and good functional outcomes.