Hand/finger Replantation

“Replantation” is the surgical reattachment of a finger, hand, or arm that has been completely separated from a person. The goal of replantation surgery is to reconnect the separated part. This is done if it can give the patient back better function and appearance. This procedure is recommended if the replanted part is expected to be successful.

In some cases, replantation is not possible. The part or residual limb injury area can be too damaged. If the lost part cannot or should not be reattached, your surgeon may offer to clean, smooth, and cover the cut end. This is called a completion or revision amputation. In some cases, this option will give you a better and faster recovery than replantation. Therefore, even if replantation is possible, it is not always the best treatment.

Replantation surgery requires very specialized medical care. It requires the skills of a highly trained surgeon and an extensive support team in the emergency room, operating room, and hospital. Not every emergency room or hospital can provide this care. Therefore, it may require coordination of care to send the injured patient and part to a trauma center that has the capacity to take care of this type of injury.

The time elapsed from the injury to treatment is important. The separated part of the body does not have the blood supply, oxygen, or nutrients to support the tissue. Therefore, progressive tissue injury occurs over time. There are some options to help increase options for replantation. The separated part can be rinsed off quickly with water or saline. The part should then be wrapped in wet gauze and put in a sealed plastic bag. This bag can then be placed in ice water to keep the part cool.

It is important to try to be aware of how much time has passed since the injury, and there are several steps to measure time without blood flow (ischemia time).

Record the time from the injury to the time when the separated part started cooling. This is called warm ischemia time. The time from cooling to replantation should also be recorded. This is called cold ischemia time. These times can affect treatment decisions and the success of surgery.

Procedure

There are three main steps in the replantation process:

Step 1: Damaged tissue is carefully removed
Step 2: Bone ends or fractured parts are reconnected with pins, wires, or plates and screws
Step 3: Muscles, tendons, arteries, nerves, and veins are repaired; sometimes, grafts (from your own body or a tissue bank) or artificial spacers of bone, skin, tendons, and blood vessels are needed, too

Patients have a very important role in the recovery process after leaving the hospital. Generally, patients should:

Avoid smoking, as it may cause loss of blood flow to the replanted part
Avoid ice, which may decrease blood flow
Keep the replanted part above heart level to increase circulation

Other factors that may affect recovery are:

Age: Younger patients have a better chance of their nerves growing back, and they may regain more feeling and movement in the replanted part
Area of injury: Generally, more use will return to the replanted part if it is further down the arm
Joint vs. non-joint injury: More movement has a better chance of returning for patients who have not injured a joint
Severed vs. crushed body part: A cleanly cut-off part usually regains better function after replantation than one that has been pulled off or crushed
Weather: Cold weather may be uncomfortable during recovery, regardless of how well your recovery is going

Acute burn

Head and neck reconstruction

Hand Deformity Correction

Limb Reconstruction

Facial Trauma