Alternative Names reattachment of amputated fingers or toes, reimplantation of digits
Definition Replantation of digits is the reattachment of fingers or toes that have been completely cut off, or amputated.
Who is a candidate for the procedure? Someone whose fingers or toes have been amputated is a candidate for this procedure. It is usually an emergency procedure, done within a few hours of the injury.
How is the procedure performed? The amputated digits are kept cool before surgery. This is done by wrapping the digits in gauze moistened with saline, or a salt solution. The digits and gauze are placed inside a bag and set on ice to keep them cool. This helps to preserve the amputated parts. For best results, the replantation should be done within 4 to 6 hours of the injury.
Replantation of digits can be performed under general anaesthesia. This means that the person is put to sleep with medication. The surgery may also be done using a nerve block, or "numbing" medication. In this case, the person is awake but has no pain.
The bone ends of the affected finger or toe are shortened. This is done to decrease tension on the repaired arteries, veins, and nerves. Wires may be used to stabilise the bones. The tendons are then repaired. Because they are so small, the nerves and vessels are repaired using a microscope. Once the repair is done, the hand or foot is wrapped in a dressing. A cast may be applied after surgery to protect the replanted digit.
What happens right after the procedure? The person may go to the surgery recovery room for a short period after the replantation. The arm or leg is kept elevated to prevent swelling. Close attention is paid to the condition of the skin of the replanted digit. The tip of the finger or toe is left exposed when the dressing is applied. This allows the doctor to check for good blood supply to the digit.
Analgesia will be given as needed. When the anaesthesia has worn off, the person will go to his or her hospital room. Although recovery depends on the extent of other injuries and how fast the person heals, most people spend a few days in the hospital.
What happens later at home? The hand or foot should be kept elevated to prevent swelling. The finger or toe should be watched closely for signs of infection, or death of the tissue. Any redness, swelling, drainage, or change of colour in the tip of the digit should be reported to the health care doctor. The person usually needs physiotherapy or occupational therapy after replantation of a digit. This helps to strengthen the muscles and tendons. Even with therapy, the person may not regain full use of the digit.
What are the potential complications after the procedure? There are potential complications with any surgery. These include bleeding, infection, and allergic reactions to anaesthesia. Complications from replantation include death of the replanted tissue, and decreased nerve function or use of the digit. Cosmetic deformity may also occur.
Author: Gail Hendrickson, RN, BS Reviewer: eknowhow Medical Review Panel Editor: Dr John Hearne Last Updated: 12/06/2005 Contributors Potential conflict of interest information for reviewers available on request
