Cross-limb vascular shunting for major limb replantation.

摘要

Sir, I read with interest the recent article by Dr. Yao-Chou Lee, MD, and Jing-Wei Lee, MD. I agree with the authors on the use of extra anatomic cross-limb shunting to simplify and expedite the revascularization process. I also congratulate them for their 2 successful cases. However, we usually debride both stumps before vessel coaptation throughout replantation. This can make your operative field clean and diminish blood loss. The operative field will be obscured after vascular shunting. Conversely, it will prolong ischemic time if we apply a tourniquet. Therefore, I recommend that we do debridement and tag structures over the stump of the amputee on another table during the period of patient transportation, anesthesia, and preoperative aseptic preparation. It will save about 20 to 30 minutes. Then, we start to do vascular shunting and remaining procedures.