Replantation

What is replantation?

“Replantation” refers to the surgical reattachment of a limb, e.g. a finger, hand, or arm, that has been completely and traumatically cut from a person’s body, also known as amputation. The goal of replantation surgery is to give the patient back as much use of the injured limb as possible. In some cases, replantation is not possible because the part is too damaged. If the lost limb cannot be reattached, a patient may have to use a prosthesis (a device that substitutes for a missing part of the body) to restore and improve function.

Replantation is recommended when the replanted limb will work at least as well as a prosthesis. Generally, a missing hand or finger would not be replanted knowing that it would not work, be painful, or get in the way of everyday life. Before surgery, the doctor, if possible, will explain the procedure and make a shared decision with the patient regarding replantation surgery.

How is the replantation procedure done?

There are a number of steps in the replantation process. First, damaged tissue is carefully removed. Then bone ends are shortened and rejoined with pins or plates. This holds the part in place to allow the rest of the tissues to be restored to a normal position. Muscles, tendons, arteries, nerves and veins are then repaired.

What is recovery from replantation surgery like?

The patient has the most important role in the recovery process. Smoking causes poor circulation and may cause loss of blood flow to the replanted part. Allowing the replanted part to hang below heart level may also cause poor circulation. Younger patients have a better chance of their nerves growing back; they may regain more feeling, and may regain more movement in the replanted part. Generally, the further down the arm the injury occurs, the better the return of use of the replanted part to the patient. Patients who have not injured a joint will get more movement back than those with a joint injury. A cleanly cut part usually works better after replantation than one that has been crushed or pulled off. Recovery of use depends on re-growth of two types of nerves: sensory nerves that let you feel, and motor nerves that tell your muscles to move. Nerves grow about an inch per month. The number of inches from the injury to the tip of a finger gives the minimum number of months after which the patient may be able to feel something with that fingertip. The replanted part never regains 100% of its original use, and most doctors consider 60% to 80% of use an excellent result. Cold weather may be uncomfortable and provide reason for frequent complaint even for those with excellent recovery.

What about therapy and rehabilitation after replantation?

Complete healing of the injury and surgical wounds is only the beginning of a long process of rehabilitation. Therapy and temporary bracing are important to the recovery process. From the beginning, braces are used to protect the newly repaired tendons but allow the patient to move the replanted part. Therapy with limited motion helps keep joints from getting stiff, helps keep muscles mobile, and helps keep scar tissue to a minimum. Even after recovery,patients may experience functional limitation. Tailor-made devices may help many patients do special activities or hobbies. Talk to your physician or therapist to find out more about such devices. Many replant patients are able to return to the jobs they held before the injury. When this is not possible, patients can seek assistance in selecting a new type of work.

Are emotional problems common following replantation?

Replantation surgery can have emotional effects.When seeing the replanted part for the first time, feelings of shock, grief, anger, disbelief, or disappointment are fairly common. Worries about the look of a replanted part and how it will work are common. Talking about these feelings with a doctor or counselor/therapist can help.

Will additional surgery be necessary after replantation surgery?

After replantation surgery, some patients may need additional surgery at a later time to gain better function of the part.

Some of the more common procedures are:

• Tenolysis: frees tendons from scar tissue.
• Capsulotomy: releases stiff, locked joints.
• Tendon or muscle transfer: moves tendons or muscles to another spot so that they can work in an area that needs the tendon or muscle more.
• Nerve grafting: replaces a scarred nerve or a gap in the nerves to improve how the nerve works.
• Late amputation: removing the part because it does not work well, interferes with use of the hand, or has become painful.

Used with permission from American Society for Surgery of the Hand.