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Replantation of Finger & Hands

Dr Ronald Malt, an American clinical surgeon, has performed the first replantation at Massachusetts Hospital in May 1962 on a 12-year boy who had his right arm amputated in a train accident. It’s been around 60 years since the first replantation; thousands of amputated body parts have been reattached till now, preserving the quality of life of thousands of people by improving the function and appearance of amputated body parts.

Since Dr Malt’s first replantation of the hand, medical technology has advanced, and the microscope’s invention improved the replantation of many other parts, including fingers of both hands and legs, all facial parts, scalps, and at times genitalia as well.

Replantation is defined as the reattachment of a body part surgically, like a finger or hand, that has been totally separated from a person’s body. This procedure is suggested if the replanted body part functions without pain and doesn’t cause any further problems. In some cases, replantation is not possible if the body part is crushed or damaged too much.

Depending on the injury type, surgical experts can replant some separated limbs. Replantation of upper extremities such as arms, hands, and fingers is more common while lower limbs are like toes, feet, legs are less common.

Limb Replantation Surgery

In most of the cases, limb replantation should process within hours after experiencing traumatic lesions. The surgeon follows several steps in the replantation process of the arm, hand, finger, etc.

Step1 – First, the damaged tissue from the part is removed carefully
Step2 – The bony ends are trimmed and rejoined. For stability, surgeons use pins, wires, or plates and screws. They can hold the parts together and allow the healing process to restore the tissues.
Step3 – Veins, nerves, arteries, muscles, and tendons are joined together. In some cases, grafts or artificial spacers of bone, tendons, and blood vessels are required. It is done through free-tissue transfer in which a piece of tissue is taken from another body part, along its arteries and veins. It helps to restore blood flow; repair damaged nerves and bones.

For some patients, even skin is also transferred, which has been taken from other parts of your body.

Things You Should Know About Limb Replantation

  • Replantation needs microsurgery. It should be done within hours from the part’s amputation with specialized equipment, surgeons, and other supporting staff.
  • The possibility of a successful replantation improved if the amputated part was preserved in a cool & clean environment as soon as possible.
  • Amputated parts should be wrapped in a moistened gauze material and stored in a sterile bag with water.
    Don’t use dry ice; it freezes the tissue.
  • Parts like fingers can be replanted up to 94 hours in some cases, typically, 12 hrs is the max ischemic time tolerated.
  • Parts with major muscle groups like arms should be replanted within 6 to 8 hrs to have a well functional limb.
  • It is also essential to preserve the amputates even they are not good enough for replantation. This is because a surgeon requires all available human tissue to cover the injury as much as possible and prevents further shortening.
  • In the case of multiple amputations, tissues along the nerves and vessels are taken from a non-replantable part and used as graft material for a replanted part.
  • The repair of nerves and vessels of the amputated parts are done using an operating microscope during replantation. It is termed microvascular replantation.
  • Tenolysis is an additional surgery performed after replantation of an amputated part to free the tendons from scar tissue.
  • A capsulotomy is another surgical procedure done after replantation to release stiff and locked joints.

If the part replanted does not work or has become painful due to any reason, it is removed permanently, which is termed as late amputation.

Results Of Replantation

The fact is that replanted parts may never regain 100% functional use, and most surgeons assure an excellent 60% to 80% result. In general, patients without joint damage will get more movement back than with a damaged joint. A part that has amputated cleanly works fine after replantation than the part that has crushed or pulled off.

Younger people have a better possibility of growing back their nerves compared to adults. They might recover faster and might regain more functionality of the replanted part.

There are a lot more things you need to know about the Replantation of Limbs. If you or any known person have improper functioning replanted body parts, don’t hesitate to consult our limb replantation experts. For information, Book An Appointment or call us on +91 7675808080.