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Replantation of digits
Definition
Replantation of digits is surgery to reattach fingers or toes that have been cut off (amputated).
Alternative Names
Revascularization of amputated digits; Reattachment of amputated fingers
Description
This procedure is done using regional or general anesthesia. The ends of the bone may be shortened to remove tension on the repaired blood vessels. The surgeon places the finger or toe (called the "digit") in place and stabilizes the bone with wires or a plate and screws.
Tendons are repaired next, followed by nerves and blood vessels. Nerve and blood vessel repair are the most important step to the success of the procedure.
After all repairs are complete, the wound is closed and a bandage (called a bulky dressing) is applied. Young children may need to wear a cast to protect the area from injury.
If you have a partial (incomplete) amputation, part of the toe or finger stays attached to the body by skin, artery, vein, or nerve. In this case, a process called revascularization is used to reattach the finger or toe.
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 for this surgery include the following:
- Death of the replanted tissue
- Reduced nerve or movement function in the replanted digit
- Stiffness of the fingers
- Pain that continues after surgery
After the Procedure
Special care will be taken while you are in the hospital to make sure blood flows properly to the reattached part. The arm or leg will be kept raised. The room may be kept warm to ensure proper blood flow.
After you are released from the hospital, you may need to wear a cast to protect the part.
Proper care of the amputated part or parts is very important to successful replantation. Under the right conditions, there is a good chance that the surgery can restore the use of the finger or toe. You will need follow-up visits with your health care provider, who will continue checking blood flow in the surgery area.
Outlook (Prognosis)
Children are better candidates for replantation surgery because of their greater ability to heal and regrow tissue.
Replantation of an amputated part is ideally done 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.
You will not have the same flexibility in the finger or toe after surgery. Pain and sensation changes may continue.
References
Chai Y, Kang Q, Yang Q, Zeng B. Replantation of amputated finger composite tissues with microvascular anastomosis. Microsurgery. 2008;28:314-320.
Lyn ET, Mailhot T. Hand. In: Marx JA, ed. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa: Mosby Elsevier; 2009:chap 47.
Halluksa-Handy M. Management of amputations. In: Roberts JR, Hedges JR, eds. Clinical Procedures in Emergency Medicine. 5th ed. Philadelphia, Pa: Saunders Elsevier; 2009:chap 47.
Gross KR, Collier BR, Riordan WP Jr, Morris JA Jr. Wilderness trauma and surgical emergencies. In: Auerbach PS, ed. Wilderness Medicine. 6th ed. Philadelphia, Pa: Mosby Elsevier; 2011:chap 21.
Reviewed By: Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington. C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.
