reimplanted limb

(May-2007 Q14) An otherwise fit 30 yr old man is having microvascular reimplantation of his forearm. Describe methods available to optimise the perfusion of the perfusion of the reimplanted limb in the post-operative period.

Pharmacological and non pharmacological

Pharmacological :

1) regional anaesthesia induced sympatholysis and vasodilation of upper limb arterioles

2) dextran: polysaccharide, inhibits , promotes microvascular blood flow

Non pharmacological

1) keeping reimplanted limb warm

2) ensuring adequate hydration to avoid increased vasoconstriction and SVR

3) avoiding compartment syndrome, keeping replanted limb elevated

4) optimal Hb

5) appropriate monitoring of BP

6) monitoring of limb, early management of ischaemia

7) ?optimising venous pressure?

Although the question asked for management in the post operative period, no candidate was marked down for discussion involving intra-operative factors affecting post operative management.