Replantation

Replantation is the surgical reattachment of a finger, hand or arm that has been completely cut from a person’s body The goal of this surgery is to give the patient back as much use of the injured area as possible. This procedure is recommended if the replanted part is expected to function without pain.

These are devastating injuries where parts of the limbs are severed, either completely or incompletely can involve the whole limb (termed major amputations) or just the fingers (termed digital or minor amputations). Major replantation involve the limb at the wrist, forearm, elbow or upper arm levels. They are termed major as they can be life-threatening, and the amputated part contains a lot of muscles, making it not being able to survive more than 4-6 hours without blood flow. Muscles tolerate ischemia (lack of oxygen) poorly, and this period of ischemia can be prolonged by cooling the amputated part.

After stabilizing the patient’s condition, major surgeries need to be operated on immediately to reconnect the blood circulation to the severed part as quickly as possible. Establishment of circulation is first achieved with a shunt (tube) connecting from the artery of the stump to the artery of the amputated part. Formal replantation (re-attachment) involves debridement (removal of dead or contaminated tissues), bone shortening and fixation, repair of tendons and muscles, and re connection of the nerves and blood vessels under microscopic magnification, The skin is then closed, or covered with skin graft or flap.