Replantation

Illustration of replantation after a finger, hand, or arm has been completely separated
Figure 1. Replantation refers to the surgical reattachment of a finger, hand, or arm that has been cut completely from a person’s body.

Replantation is the surgical reattachment of a finger, hand, or arm that has been completely separated from a person. The goal of replantation surgery is to reconnect the separated part when doing so is expected to give the patient better function and appearance.

In some cases, replantation is not possible. The separated part or the remaining limb may be too damaged. When the lost part cannot or should not be reattached, a surgeon may clean, smooth, and cover the cut end. This is called a completion or revision amputation. In some situations, this may provide a better and faster recovery than replantation.

Replantation surgery requires specialized medical care, including a highly trained surgeon and an extensive support team in the emergency room, operating room, and hospital. Not every hospital can provide this care, so coordination may be needed to transfer the patient and the separated part to a trauma center that can treat this type of injury.

Time and Transport

The time from injury to treatment is important. A separated body part no longer has blood supply, oxygen, or nutrients, so tissue injury progresses over time.

Care of the separated part: rinse the part quickly with water or saline, wrap it in wet gauze, place it in a sealed plastic bag, and then place the bag in ice water to keep the part cool.

It is helpful to record how much time has passed since the injury. The time from injury until cooling begins is called warm ischemia time. The time from cooling until replantation is called cold ischemia time. These times can affect treatment decisions and the chance of surgical success.

Procedure

There are three main steps in the replantation process:

  • Step 1: damaged tissue is carefully removed.
  • Step 2: bone ends or fractured parts are reconnected with pins, wires, plates, or screws.
  • Step 3: muscles, tendons, arteries, nerves, and veins are repaired. Sometimes grafts from the patient’s body or a tissue bank, or artificial spacers of bone, skin, tendons, and blood vessels, are needed.

Recovery

The initial recovery takes place in the hospital for days or weeks so the care team can monitor the reattached part and make sure it has good blood flow. Sometimes another trip to the operating room is needed to improve blood flow. Transfusions or medicinal leeches may be needed to help keep blood flowing to the reattached part.

Patients have an important role in recovery after leaving the hospital. In general, patients should:

  • Avoid smoking, which may reduce blood flow to the replanted part.
  • Avoid ice, which may decrease blood flow.
  • Keep the replanted part above heart level to increase circulation.

Factors That Affect Recovery

  • Age: younger patients have a better chance of nerve regrowth and may regain more feeling and movement.
  • Area of injury: more use may return when the injury is farther down the arm.
  • Joint vs. non-joint injury: patients without a joint injury may have a better chance of regaining motion.
  • Severed vs. crushed part: a cleanly cut-off part usually regains better function than one that has been pulled off or crushed.
  • Weather: cold weather may remain uncomfortable during recovery.

Use of the replanted part depends partly on the regrowth of sensory nerves, which help you feel, and motor nerves, which tell muscles to move. Nerves grow about one inch per month. The number of inches from the injury to the fingertip gives the minimum number of months before a patient may be able to feel something with that fingertip. The replanted part never regains 100% of its original use, and many doctors consider 60% to 80% of original use an excellent result.

Rehabilitation

For replant patients

Physical therapy and temporary bracing are important to recovery. Braces help protect newly repaired tendons while allowing the patient to move the replanted part. Therapy with limited motion helps keep joints from getting stiff, keeps muscles mobile, and limits scar tissue.

Even after recovery, some activities may remain difficult. Custom devices may help patients return to special activities or hobbies. Many replant patients return to their previous jobs. When that is not possible, patients may need help selecting a new type of work.

For amputees

If replantation is not possible and amputation is chosen, therapy and rehabilitation remain important. A prosthesis may be used to substitute for the missing body part. Newer technologies can repair nerves to existing muscles in an amputation, which may help power a myoelectric prosthesis or “bionic arm.” This is called targeted motor reinnervation. Connecting sensory nerves to muscles can also reduce residual limb and phantom pain.

Emotional Recovery

Replantation or amputation can affect emotional life as well as the body. When bandages are removed, a patient may feel shock, grief, anger, disbelief, or disappointment because the body part does not look like it did before. These feelings are common. Talking with the doctor may help, and a counselor may also assist with this process.

Long-term Symptoms

Sometimes replantation surgery is successful and the reattached part survives, but residual pain, numbness, stiffness, cold sensitivity, or loss of use may remain. Some symptoms improve over time, while others may be permanent. If continuing symptoms are severe, a later amputation can be considered to reduce pain, improve the rest of the hand function, or allow for prosthetic use.

This mobile-friendly version is adapted from patient education content originally provided by the American Society for Surgery of the Hand.