Replantation is the procedure that is undertaken for the reattachment of the amputated part that could be arm, forearm, hand or finger. The goal is to give the patient the cut part back and return as much of the function as possible.

INDICATIONS:

• Thumb
• Multiple-digit
• Transmetacarpal
• Wrist
• Forearm
• Single digit in children
• Individual digit distal to the flexor digitorum superficialis (FDS) tendon insertion

CONTRAINDICATIONS

• Life-threatening-associated injuries
• Psychologically unstable patients
• Systemic illness (e.g., severely arteriosclerotic vessels)
• Severe crushing or avulsion
• Multiple segmental injuries of the amputated part
• Extreme contamination
• Prolonged warm ischemia time in major limb amputation

PRESERVATION OF AMPUTEE

This is a very important step. The amputee should be washed properly, wrapped in moist gauze and placed in a plastic bag, which in turn needs to be placed in another bag filled with ice.

PROCEDURE

It is a long procedure and sometimes takes 6-8 hours or more to restore the continuity. Different steps of procedure include:

Removing all the dirt and non-viable tissue and shortening the bone.

Fixation of bone by means of wire, plate or screws. 

Repairing tendons, arteries, veins and nerves and skin.

The order may vary depending upon the hours since the amputation took place.

COMPLICATIONS

• Failure of replant.
• Stiffness of fingers.
• Bone healing problems like nonunion, malunion 
• Loss of range of motion
• Cold intolerance
• Pain and numbness
• Infection

CHANCES OF SUCCESS

Usually 50*75 % depending upon the type of injury, the zone of injury, the time since injury and the peri-operative care.

ALTERNATE OPTION

The alternate option is to get the amputated part shortened and closed properly and use prosthesis. 

APPROXIMATE HOSPITAL STAY

5-7 days depending upon the recovery. 

LONG TERM EFFECTS

• Long term rehabilitation therapy.
• Emotional support.
• Cold intolerance
• Multiple procedures for restoration of different hand functions e.g. release of the tendons, release of joints, late amputations etc

 

Written by :  Dr. Batool Urooj

Copyrights: Pakistan association of Plastic Surgeons