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Replantation
“Replantation” refers to the surgical reattachment of
a finger, hand, or arm that has been completely cut from a person’s
body (see Figure 1). The goal of replantation surgery is to give the
patient back as much use of the injured area as possible. In some cases,
replantation is not possible because the part is too damaged. If the
lost part cannot be reattached, a patient may have to use a prosthesis
(a device that substitutes for a missing part of the body). In many
cases, a prosthesis may give a person without hands or arms the ability
to function better than they would without the prosthesis.
Replantation is usually recommended when the replanted
part 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 how much use is
likely to return following replantation. The patient or family member
must decide whether that amount of use justifies the long and difficult
operation, time in the hospital, and months or years of rehabilitation.
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.
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.
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 you have recovered, you may find that you
cannot do everything you wish to do. 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.
Replantation
can affect your emotional life as well as your body. When your bandages
are removed and you see the replanted part for the first time, you
may feel shock, grief, anger, disbelief, or disappointment because
the replanted part simply does not look like it did before. Worries
about the look of a replanted part and how it will work are common.
Talking about these feelings with your doctor often helps you come
to terms with the outcome of the replantation. Your doctor may also
ask a counselor to assist with this process. You may find it helpful
to talk with someone about it, and work through your feelings so you
can move on with your life.
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.
Stay in the flow of life. You have many great gifts.
Even with the best medical care, you need to be strong during the
course of recovery. Remember that quality of life is directly related
to your attitude and expectations — not on just regaining limb
use.
Replantation
Replantation refers to the surgical
reattachment of a finger, hand, or arm that has been completely cut
from a person’s body.
© 2006 American Society for Surgery of the
Hand
Developed by the ASSH Public Education Committee
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replantation,
replant, reattach, attach, detached, amputate, amputated, amputation
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