Replantation, especially of multiple digits, is a time and motion study, a disciplined routine that requires leadership from the outset to prevent it from degenerating into rudderless Brownian movement by wide-eyed residents each demanding ''give me a go at this.'' Direction includes communication with anesthetists regarding the likely duration and potential requirement for dextran therapy, antibiotics and anticoagulation, and the awareness of its risks if a brachial plexus block or indwelling catheter is to be used. The patient's temperature needs to be maintained to favor peripheral vasodilation. Care is taken with preparing the amputation stump so as not to disturb blood clots, which can be useful markers of the position of dorsal veins in particular.
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