20250520 Quiz Dr Ling Hui

A 40-year-old pianist has a crush-avulsion amputation of her dominant hand index and middle fingers at the PIP level. She came to ED after 9 hours with all the amputated parts. What aspect most influences your decision to proceed with replantation?

• A. Within warm ischemia time

• B. Dominant hand involvement

• C. Proximal level of injury

• D. Occupational demand requiring fine motor control

• E. Crush-avulsion injury may be salvageable with vein grafts

A 26-year-old woman sustains an amputation of her index finger at the level of the distal phalanx with segmental loss of digital artery and nerve. The surgeon plans a replantation using vein grafts. What is the optimal choice for vein graft harvest in this scenario?

• A. Cephalic vein from the contralateral forearm

• B. External jugular vein

• C. Saphenous vein from the leg

• D. Basilic vein from ipsilateral forearm

• E. Dorsal venous arch from foot

A 37-year-old man undergoes successful replantation of the index and middle fingers. On post-op 24 hours, the replanted digits become pale, cool, and capillary refill is sluggish. What is the next most appropriate step?

• A. Apply warm packs and monitor

• B. Start IV heparin and observe

• C. Return to OR for exploration

• D. Add caffeine to increase perfusion

• E. Order duplex ultrasound

A replanted digit develops venous congestion on post-op day 1. Which of the following is the first-line management?

• A. Immediate return to OR

• B. Application of medicinal leeches

• C. Removal of dressings and tight sutures

• D. Increasing systemic heparin infusion

• E. Arrange for doppler ultrasound study

A 45-year-old man with schizophrenia and poorly controlled diabetes presents with a crush-avulsion amputation of the ring and little finger through the PIPJs. He is 8 hours post-injury, and the amputated parts were not stored on ice before he came to ED. What is the best course of action?

• A. Attempt replantation of both digits to preserve function

• B. Replant only the ring finger due to its more central role

• C. Revision amputation and functional optimization

• D. Proceed with replantation using aggressive anticoagulation

• E. Delay surgery and monitor for tissue viability