In a replantation of a completely amputated ring finger at the zone II level, the optimal order of structure repair to maximise survival is:

• A Bone fixation → Extensor tendon → Flexor tendon → Artery → Veins (2:1 ratio) → Nerves → Skin ✓
• B Skin closure → Tendons → Nerves → Arteries → Veins → Bone
• C Arteries first to reperfuse digit → Bone fixation → Tendons → Veins → Nerves
• D Nerves → Tendons → Bone → Arteries → Veins → Skin

Explanation

The standard sequence for digital replantation follows a systematic 'bone-tendon-vessel-nerve' order: (1) bony shortening and fixation (K-wires or mini-plate) to allow tension-free vascular repair, (2) extensor tendon repair, (3) flexor tendon repair, (4) arterial anastomosis to restore perfusion, (5) venous anastomoses (ideally two veins per artery for adequate outflow), (6) nerve coaptation, and (7) skin closure without tension. Bone fixation before vascular repair is essential because manipulating a reperfused digit risks anastomosis disruption. The 2:1 venous-to-arterial ratio reduces congestion and improves survival.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.