Reconstructive Hand Surgeon

Chattanooga, Tennessee

Replantation

Among the more traumatic injuries we see at the Hayes Hand Center is a severed hand or finger. Replantation (reattachment) of hands and fingers must be considered whenever replantation is expected to work as well as a prosthesis would. Because the function of opposable fingers and thumb is essential to proper hand function the hand specialists at Hayes Hand Center make every effort to replant severed digits while restoring the maximum amount of function and sensation.

Successful replantations depend upon many factors, and these help the hand surgeon decide whether to attempt replantation. The importance of the severed part(s) help the surgeon and patient determine if the risks and benefits of surgery are worthwhile. The severity of the injury determines whether the tissue is salvageable. Factors that affect the successful return of function include how the tissue was severed (guillotine cut or crush injury), and the degree and type of damage to bones, nerves and blood vessels.

The decision to undergo replantation is a major one. Surgery, hospitalization and rehabilitation are all long and difficult. This investment in time, expense, effort and imposition must be weighed against the benefits of regaining the use of the lost body parts.

Emergency Care and Treatment

Severed fingers or hands should be wrapped in gauze saturated with normal saline (salt water whose salt content is the same as the human body.) The part(s) should be sealed in a plastic bag and placed on ice using caution not to freeze any of the tissue. Avoid putting the parts in plain water as this can damage the tissue and lessen re-attachment success.

Blood vessels in the stump of the limb should not be clamped during initial care and transport to the emergency department. Instead, compression and elevation should be employed to reduce blood loss and tissue damage.

Surgical Replantation and Recovery

Replantation surgery should begin as soon as possible. Success is most reliable if replantation is done within 24 hours when the part is kept cold, or 12 hours if the part has not been kept cold. 

Once the patient has arrived at the emergency department x-rays of the stump and severed part(s) will be necessary. Surgical preparation, including prophylactic antibiotics should be started, and surgery begun as soon as possible.

Recovery and rehabilitation can take years and places high demands on the patient to comply with treatment plans. Patients need physical therapy and, many need counseling to deal with emotional reactions to the injury, loss, and changes they experience.

Replantation Outcomes

Overall success rates for replantation range from 77% for guillotine-type amputations versus crush amputations at 49%. The cleaner cut from guillotine amputations causes less tissue damage than crush amputations, improving the chances for success.

Successful healing will not regain full function of the replanted parts. Surgeons consider regaining 60-80% of previous function to be an excellent outcome. However, if regaining any amount of function allows you to continue your work, improves your activities of daily living, or improves your life in general, replantation of hands or fingers is well-worth considering.

If you or a loved one has suffered an amputation of a hand or finger(s) please contact the our reconstructive hand surgeon at the Hayes Hand Center in Chattanooga, Tennessee as soon as possible for a full replantation evaluation and treatment.