Replantation of digits

• Alternative Names

  Revascularization of amputated digits; Reattachment of amputated fingers

• Description

  The patient is sedated using regional or general anesthesia. The bone ends may be shortened to remove tension on the repaired blood vessels. The finger or toe is put in place and the bone is stabilized with wires or a plate and screws. Tendon repairs are done next.

  The nerves and vessels are then repaired with special surgical instruments. This part of the surgery is most critical to its success. The skin is then closed. A bulky dressing is applied.

  Young children may need to wear a cast to protect the area from injury.

  With an incomplete amputation, part of the digit stays attached to the body by skin, artery, vein, or nerve. A process called revascularization is used to reattach the rest of the digit.

• Why the Procedure Is Performed

  The surgery is recommended in a case of amputated fingers or toes, when the fingers or toes are in a condition that would allow replantation.

• Risks

  Risks for any anesthesia include the following:

  • Reactions to medications
  • Problems breathing

  Risks for any surgery include the following:

  • Bleeding
  • Infection

  Additional risks include the following:

  • Death of the replanted tissue
  • Reduced nerve or movement function in the replanted digit
• After the Procedure

  Children are especially good candidates for replantation surgery because of their great ability to heal and regenerate tissue. Replantation of an amputated part is ideally performed within 4 - 6 hours after the injury. However, success has been reported up to 24 hours after the injury if the amputated part has been cooled.

  Proper care of the amputated part or parts is critical to successful replantation. Under the right conditions, there is a good likelihood that the surgery can restore the use of the finger or toe.

• Outlook (Prognosis)

  Special care is needed in the hospital to monitor and maintain the blood flow to the replanted part. The arm or leg will be kept raised. The room may be kept warm to ensure that blood flow to the skin is not changed due to cooling.

  After discharge from the hospital in about a week, you may need to wear a cast to protect the part. The health care provider will need to continue checking blood flow in the digit.

• References

  Chai Y, Kang Q, Yang Q, Zeng B. Replantation of amputated finger composite tissues with microvascular anastomosis. Microsurgery. 2008;28:314-320.

Review Date: 7/17/2008

Reviewed By: Andrew L. Chen, MD, MS, Orthopedist, The Alpine Clinic, Littleton, NH. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.