Replantation of forearms, hands, and digits is a surgical procedure used to reattach lost or amputated extremities using reconstruction techniques. It restores lost or damaged functionality and helps to improve the patient’s overall quality of life. This procedure is considered a complicated operation because it involves the complex anatomy of the patient’s arms and hands. The success rate is often determined by the experience of the medical team, along with the severity and location of the amputation or loss.
Replantation of forearms, hands, and digits is a reconstructive surgical procedure that is used to reattach lost or amputated extremities. This process involves restoring lost or damaged functionality as well as providing improved quality of life for the patient. It is a complicated operation that involves the complex anatomy of the patient’s arms and hands.
The success rate of the procedure is often determined by the experience of the medical team, along with the severity and location of the amputation or loss. To successfully reattach the extremity, vascular supply, nerves, muscles, and bones have to be reconnected. This process usually requires multiple microsurgeries and may take several hours.
Different Types of Replantation
Replantation of the extremities can be categorized into two primary types; primary and secondary replantation. Primary replantation is the optimal type of procedure, where the part of the extremity is quickly reimplanted after the amputation or loss. When the removed or separated part of the extremity cannot be immediately reinserted, it is considered a secondary replantation, which is a more complex and extensive procedure. Both types of replantation require the complete restoration of the extremity involved.
The benefits of replantation of forearms, hands, and digits include restoration of function, improved quality of life, and improved surgical outcomes. Replantation can restore lost or damaged functionality and result in significant improvements in the patient’s overall quality of life. Because of the complexity of the procedure, it is best performed by an experienced medical team with the most current techniques.
Successful replantation of the extremities will allow the patient to regain full functionality and movement and return to their regular activities. Additionally, it can help to reduce the risk of further complications from the injury and potentially reduce the need for prosthetic limbs or other medical intervention.
The expected results of replantation of forearms, hands, and digits vary greatly depending on the severity of the injury. As a general rule, the more severe the amputation, the more complex and exhaustive the procedure will be. In some cases, the severed parts of the extremity may not be able to be reattached, in which case the patient may need to be fitted for a prosthetic limb.
The most successful replantation outcomes occur when the severed extremity can be reattached within a few hours after the amputation. Even when successful, patients may experience some numbness or reduced movement in the reattached area due to nerve damage.
Most people who undergo replantation of forearms, hands, and digits experience improved outcomes and better functionality than if they had received a prosthetic limb (or no treatment at all). However, it is important for the patient to understand that recovery time and results may vary depending on the individual case.
Replantation of forearms, hands, and digits is a complex reconstructive surgery that allows for the restoration of lost or damaged functionality from amputation or loss. The success rate of the replantation depends largely on the experience of the medical team and the severity of the amputation/loss. The primary benefits of the procedure are improved functionality, improved quality of life, and improved surgical outcomes. The expected results of the procedure can vary greatly, ranging from full functionality to no improvement at all. Ultimately, replantation is a risky but potentially life-enhancing procedure and is best performed by an experienced medical team.
Definition & Overview
Unlike some species, humans cannot grow limbs once amputated. However, there is a possibility that the limb may be reattached to its original position through a surgical procedure called replantation. The procedure involves reconnecting the bone, nerves, and blood vessels of the amputated part and its origin.
Over 90% of amputation cases involving the upper extremities are caused by trauma. Unfortunately, not all of them are good candidates for a replantation procedure. Several factors need to be considered before any attempt to reattach the amputated part can be performed. Such factors include:
- Condition of the amputated part
- Length of time the amputated part has been deprived of blood
- Mental and physical health of the patient
If the amputated part has been severely damaged or if the blood vessels have been damaged beyond repair, it is no longer possible for a doctor to reattach it.
Moreover, amputated parts must be reattached within a few hours of amputation. Parts that contain large amounts of muscle must be reattached within 6 hours. Those that do not contain muscle may last up to 12 hours.
It is important to understand that aside from ensuring that the detached part is reattached within the prescribed time limits, it is also imperative that the part is preserved as best as possible. The amputated part must be placed in a sterile container at temperatures close to freezing. The temperature must not reach or exceed freezing levels.
One way to accomplish this is to place the part in a bag or container with water and ice. Dry ice cannot be used as it could destroy nerves, tissue, and blood vessels.
If possible, every part of the amputated limb or digit must be retrieved, even though it may not seem to be salvageable. It will be up to the surgeon to decide which parts can still be used.
The physical and mental condition of the patient will also determine whether the procedure will be successful or not. For instance, patients with medical conditions that prevent them from being under the influence of an anaesthetic for prolonged periods are not good candidates for a replantation procedure. Those with medical conditions, such as hypertension, diabetes, or vascular disorders are likewise not good candidates.
Additionally, those with a psychological condition may have a problem recuperating, thus would also not be considered for the procedure.
Who Should Undergo & Expected Results
People of any age may undergo the procedure. However, studies show that children have a better response. In fact, almost any part of a child’s body may be replanted if it meets certain conditions. Anybody who has undergone trauma resulting in an amputation of the forearm, hand, or digit should attempt to undergo a replantation procedure regardless of the condition of the amputated part. Those that have lost a thumb or multiple digits, a part of their hand, the entire hand from the wrist, or the forearm are good candidates for the procedure as long as the amputated part is still in a good condition.
However, it is important to note that undergoing a replantation procedure does not necessarily mean that it will be successful. There is still a possibility that the procedure may result in a total or partial failure. A total failure indicates that the attached portion did not survive after the procedure. A partial failure would mean that the attached part only regains 50% of its motion, or lower.
If the procedure is successful, the patient should regain almost 100% of the replanted part’s motions.
How Does the Procedure Work?
The replantation of the forearm, hand, and/or digits involves reattaching the nerves and tiny blood vessels. To increase the chances of a successful procedure, surgeons will need to perform microsurgery.
Prior to the procedure, doctors will need to ensure that the separated part has been cleaned thoroughly and kept in a sterile environment. The procedure will then take place in a certain sequence.
- First the surgeon will reattach the bone/s.
- Next will be the repair of the extensor tendon.
- The arteries will follow and then the veins.
- The last three parts will be the flexor tendon, nerve, and skin. In some cases, flap surgery may be needed to cover the area if skin has been severely damaged.
- If multiple fingers of the hand have been amputated, the surgeon will first repair the thumb, then the long finger, the small finger, and lastly the index finger.
After the procedure, the patient will be closely monitored so that any problems can be identified and promptly addressed. The environmental temperature will be key in the success of the procedure. The patient needs to be kept in a warm room, or one with an 80 degree Fahrenheit temperature. Even the patient’s skin temperature will be closely monitored as changes over 2 degrees will indicate a problem.
Possible Risks and Complications
As mentioned earlier, there is a possibility that the procedure may end up in a failure. Aside from this, there are also possibilities of complications developing. Some complications are myonecrosis, myoglobinuria, infections, and intolerance to cold environments.
When it comes to regaining normal function of the amputated limb or digit, age will play a factor. This is particularly true for older patients with zone 2 amputations. Zone 2 refers to amputations that occur anywhere between the upper portion of the palm to the middle portion of the fingers.
Digit Replantation / Upper Extremity Reconstruction; Duke Orthopaedics; http://www.wheelessonline.com/ortho/digitreplantationupperextremityreconstruction
Harvey Chim, MD, Marco A. Maricevich, MD, Brian T. Carlsen, MD, Steven L. Moran, MD,Christopher J. Salgado, MD, Fu-Chan Wei, MD, Samir Mardini, MD; “Challenges in Replantation of Complex Amputations”; http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3842345/