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What is a Re-implantation procedure?

Re-implantation is a reattachment surgery of a body part, which has been amputated due to a mishap or trauma. This helps in regaining the sensation of the amputated elements, through the repair of nerves and vessels (artery & vein) to revive full functionality and appearance. It is usually done within a few hours of the amputation of a body part. Replantation can be performed upper and lower limbs to ensure correction and of parts.

Common Re-implantation of upper & lower limbs:

  • Fingers
  • Hands
  • Forearms
  • Arms
  • wrist
  • Toes
  • Feet
  • Legs

Preservation methods:

  • Amputated parts should be immediately stored in a sterile bag, which can be sealed and preserved in ice-cold water/temperature until the patient reaches a hospital to perform re-implantation.
  • The amputated body part or piece shouldn’t be stored with the help of dry ice because it can lead to freezing of the tissue death which mainly makes it non-viable.
  • Parts without major muscles like fingers can be preserved for many hours. Major muscle parts such as arms need to be re-attached and revascularized within 6–8 hours to have a viable limb.
  • The outcome of major limb replantation can be foretold by the potassium level of blood which flows out of the replanted part after revascularization.
  • A high level of potassium is an indicator of muscle and tissue death.

The procedure of Re-implantation in hands and fingers:

  1. Temporary arterial shunting in major replantation. Not necessary in parts without skeletal muscle.
  2. Flexor tendon/muscle repair.
  3. Extensor tendon/muscle repair (this may be referred to just before venous repair, so the hand doesn’t need to be turned over and turned back again).
  4. Venous repair (with vein grafts if necessary).
  5. Skin grafting or local flap if necessary.
  6. Nerve repair.
  7. Arterial repair (with vein grafts if necessary).
  8. Microvascular transplant coverage of major wounds if necessary after improved potential part survival.