When a thumb or fingers have been completely severed from the hand, replantation reattaches these digits with surgery. The goal of this surgery is to offer men and women as much restored function as possible. Replantation should also improve the appearance of the affected hand.
Contact us online today to learn more about digit replantation. The Institute of Reconstructive Plastic Surgery of Central Texas helps men and women from Austin, Round Rock and throughout Texas restore function through finger reattachment surgery.
The first successful replantation surgery was performed in 1968. In the years since then, the criteria for successful attachment surgery have become more selective. Overall, the number of digital amputations is falling. This is due to improvements in workplace safety and better protection on power tools and equipment. It’s estimated that about one-third of digital amputations are eligible for reattachment.
If the level of damage is too severe, replantation may not be possible. One prime consideration is whether the surgery will restore function to at least at the same level as a prosthetic. Surgery is not done if the finger or thumb would no longer work right after surgery, or if it would cause pain or interfere with daily activities.
Patients also need to think about whether the long surgical time, recovery and hand therapy process are enough to justify the effort. A return to full function is not realistic. Most surgeons feel that regaining 60 to 80 percent function is a very successful result. To make this decision, it’s essential for surgeon and patient to establish open and honest communication. This ensures that expectations remain realistic. In some cases, amputation may actually offer a better result in terms of function. This can be true either with or without a prosthetic.
Replantation surgery is very complex and takes a number of steps. Any damaged tissue must be removed, while retaining as much healthy bone and tissue as possible. Next, the bones of both the severed digit and the injured base are cut so the two surfaces will regrow into each other. The repair is held in place with metal pins and plates.
After the bone is set, the nerves and blood vessels are rejoined. Muscles and tendons must be repaired into a normal position as well. In some cases, using grafts of the bone, tendons, blood vessels and skin are needed to complete the procedure.
Recovery and Results
Recovery after replantation surgery may be more involved than many other hand surgery procedures. Patients are kept in the ICU for close monitoring and may require blood transfusions, antibiotics, and other care to ensure a successful outcome. Following finger reattachment surgery, it is extremely important for the patient to refrain from smoking, which causes poor circulation and prevents successful reattachment. The hand needs to be prevented from hanging below heart level for long period of time, which could also cause a limit in circulation. Typically, younger patients recover more feeling and greater range of motion compared to adults.
The final results of surgery depend a lot on the nature of the original hand or wrist injury. For example, if the joint is injured, movement may be limited after replantation. Alternatively, a very clean cut allows for a greater level of success compared to a jagged injury or crushed digit. Customized splint fabrication may be needed to give the finger the support it needs during healing.
Proper regrowth after nerve injury is essential for successful digit replantation, and is the part of the healing process that takes longest to complete. Without full motor nerve recovery, muscle movement is limited.
The Institute of Reconstructive Plastic Surgery of Central Texas offers evaluation of replantation candidates around the clock at University Medical Center Brackenridge (UMCB).