Over View

“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.

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.

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

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.

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

Recovery

The initial recovery takes place in the hospital for days or weeks to monitor the reattached part to make sure it has good blood flow. There is sometimes the need to go back to the operating room to fix the blood flow. Often, transfusions or medicinal leeches are needed to assist in keeping the blood flowing to the reattached part.

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

Rehabilitation For amputees

If replantation is not possible and an amputation is chosen, therapy and rehabilitation also play a large part in recovery. For the missing part, prosthesis (a device that substitutes for a missing part of the body) may be worn. There are also newer technologies that allow nerves to be repaired to existing muscles in an amputation. This can then be used to power a myoelectric prosthesis or “bionic arm” that can have very natural and meaningful function. This is called targeted motor reinnervation. The connection of sensory nerves to the muscles can reduce residual limb and phantom pain.