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Replantation or Reattachment

What is replantation?

Replantation is the reattachment of a finger, hand or arm that has been completely cut or detached from a person’s body. The purpose of this surgery is ultimately for the patient to regain functional usage of the reattached body part. This procedure is only recommended in a situation where the benefits outweigh the risks – our hand surgery specialist will counsel you to reattach the body part if they can ensure that it will function well and function without pain.

In some cases, replacing the detached body part is not possible because the part is too damaged. There are also scenarios, depending on age, co-morbid conditions, functional status, and work, where we may counsel you to not reattach the part – although this may seem hard to believe, our specialist will counsel you to pursue only the strategy that will allow the greatest recovery of function. If the lost part cannot or should not be reattached, we may offer to clean, smooth and cover the cut end. This is called a completion amputation. In some cases, this option will give you a better and faster recovery than reattaching the body part. In some scenarios, we can harness your body’s natural capacity for regeneration and actually regrow the lost tissue.

What does a replantation procedure entail?

Replantation of a severed body part is a technically demanding and exceptionally difficult surgery. It requires expertise in bone healing and tendon repair, as well the use of microsurgery to reattach vessels 1.0 mm or smaller in diameter. The procedure generally proceeds as follows:

  1. Exploration of the severed digit as well as the “stump” –all dead or non viable tissue will be removed to ensure only clean and healthy tissue is reattached
  2. All structures that are repaired are “tagged” for future repair
  3. The bones are then cleaned, shortened, and then reattached with wires, pins, plates, or screws
  4. The tendons or muscles are then repaired with stitches
  5. The vessels are then repaired using microsurgery techniques (this is the most technically demanding portion of the procedure, and the most critical for success)
  6. The nerves are repaired using microsurgery techniques
  7. The skin is then repaired and the body part is placed in a splint or cast to protect the repairs

What does the recovery of replantation entail?

The reattachment of a severed body part is not only technically demanding on the surgeon, but it is also very demanding on the patient. Our specialists believe that the successful outcome of any reattachment is 50% related to how well it is surgically repaired, and 50% how well patients are able to complete the recovery process, including therapy. Patients must be committed to multiple months of being unable to use the reattached part and multiple months of therapy. The patient may develop chronic pain from the reattached part. The replanted part may not regain 100% of its original function, but most would consider regaining 70% of its original function to be an excellent outcome.

We ask patients to understand that there must be a balance between letting the reattached body part rest and recover against the likelihood for tendons and joints to get stuck in place due to the necessary period of immobilization. Most patients will require at least one or two further surgeries to remove scar tissue in an attempt to improve the motion of the reattached body part.

Will I need therapy after replantation?

Absolutely. Hand therapy and the use of splints are essential to the recovery process. From the beginning, splints are used to protect the newly repaired tendons. Hand therapy is eventually used to keep the joints from getting stiff and to prevent the tendons from getting stuck.

Even after a long period of recovery, patients may find that they cannot perform all of the activities they would have hoped to do. Your surgeon will discuss devices and options to assist you in recovering some of these activities. Many patients are able to return to the jobs they held before the injury.