Replantation of digits

Alternative names
Revascularization of amputated digits; Reattachment of amputated fingers

Definition
Replantation of digits is the surgical repair of completely amputated fingers or toes. With an incomplete amputations (the part remains attached to the body by skin, artery, vein, or nerve), a process called revascularization is used to reattach the digit.

Description

While the patient is sedated, using regional or general anesthesia, the bone ends may be shortened to eliminate tension on the repaired blood vessels. The digit 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 microsurgical 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.

Indications
The surgery is recommended in a case of amputated fingers or toes, with salvaged digits in a condition that would enable replantation.

Risks
Risks for any anesthesia include the following:

• Reactions to medications
  
• Problems breathing

• Bleeding
  
• Infection

• Death of the replanted tissue
  
• Reduced nerve or motor function in the replanted digit

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 to 6 hours after injury, but 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 vital to successful replantation. Under proper conditions, the long-term prognosis for the restoration of function in the digit is quite good.

Convalescence

Special care is needed in the hospital to monitor and maintain the circulation to the replanted part. The extremity will be kept elevated. The room may be kept quite warm to ensure that circulation to the skin is not altered due to cooling.

After discharge from the hospital in about a week, the patient may need to wear a cast to protect the part. Continuing circulation checks are necessary.

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