WHAT SHOULD BE FIXED FIRST IN CRUSHING INJURY – BONE / VESSEL /SKIN !!!

  1.     Which of the following is the first one to be fixed in a crushing injury to wrist :
  • Skin
  • Extensor tendons
  • Vessels
  • Bone

Answer  : D

Explanation :   This question has been a matter of debate ?? though it is simple and clear . There are standard textbooks which mention the sequence of fixation in an amputated limb ( Microvascular Anastomosis / Reimplantation surgeries ) as follows –

 

OPERATIVE SEQUENCE OF REPLANTATION

B – Bone

E – Extensor tendon

F – Flexor tendon

A – Arteries

N – Nerves

V – Veins

S – Skin

Mnemonic – BE FAN of VS

3 comments

  1. i think crushing injury is totally different from amputation or reimplantation

    for crush injury first preference is given to vessels to prevent gangrene of viable tissue…there is no use of going for bone repair if vessel reanastomosis fails…correct me if am wrong

  2. In crush injury you repair vessels first and specifically artery , the reason being that the viability of a tissue depends on vascular supply and in crush injury it is the warm ischemia time which would affect outcome and it is between 1-2 hours therefore the vessels are repaired However often it is the vein that is a problem rather than the artery because of thinner walls of veins and often needs to be tackled instead

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