When a hand surgeon reattaches a severed finger, hand, or arm, the surgical procedure is more formally known as a replantation. When the surgery is performed, your hand surgeon will try to give patients back as much normal use of their finger, hand, or arm as possible.
Not every severed body part can be replanted; sometimes the part is too badly damaged to be reattached. In that case, a prosthesis that substitutes for the missing part may be an alternate option.
If the hand surgeon believes that the replanted part will work at least as well as a prosthesis, replantation is often the better choice. If the finger, arm, or hand isn't expected to work, or if it would cause pain or interfere with daily activities, the missing part will typically not be considered for replantation. The expected results of the surgery, including how well the replanted part will work, will be explained by your hand surgeon before the surgery is complete. The patient will be asked to weigh the expected outcome against, not only the long and difficult operation a replantation involves, but also the length of time the patient will be hospitalized and the months or years it may take to rehabilitate.
The Replantation Process
Any replantation includes a number of steps, beginning with the careful removal of all tissue that was damaged when the finger, arm, or hand was removed. Your hand surgeon will next trim the ends of the bones and attach pins or plates onto them. These will hold the replanted part in place and let the tissues heal with the replanted part in its usual position. Your surgeon will then repair the veins, muscles, and arteries that were damaged.
Recovery after Surgery
The patient, after replantation surgery, plays an extremely important role in the recovery process. For example, the patient can hinder the recovery process if he or she smokes, thereby contributing to poor circulation. Other factors play a role as well. For instance, younger patients have nerves that are more likely to grow back; greater movement in the replanted part for younger patients, therefore, is likely.
In all replantation cases, regaining use of the replanted part depends on how well two types of nerves grow back. The first nerves are sensory, which provide feeling, and the others are motor nerves, which tell the muscles how to move. Both types of nerves grow back at a rate of about an inch a month, so a rough check with a ruler from the cut to the end of the finger will indicate about how long it may take for feelings to come back to the fingertip.
The part that is replanted will not regain 100% functionality, but resuming functionality at 60% to 80% is considered by most surgeons to be excellent.
Rehabilitation and Therapy
The first step in rehabilitation is healing from the injury and the surgery, and temporary braces and therapy are a critical component of the healing process. The braces enable some movement for the replanted part, but also protect the tendons while they heal. It's important to avoid stiff joints by practicing prescribed therapy that facilitates the maintenance of flexibility, reduction of scar tissue, and activity in the muscles.
When an individual undergoes replantation of a body part, there are many different aspects related to their health, that are not just related to physical factors. For example, the emotional health of the patient is an integral factor that needs to be carefully attended to. Shock, disappointment, grief, and anger are some emotions that patients experience when their bandages are taken off. Patients are often concerns about how the replanted part will end up looking and working, and these are all concerns that need to be discussed with your surgeon. Dealing with these emotional issues is important, and patients who manage to work through such difficult concerns suggest that it greatly helps them move on with their lives.
Follow-Up & Additional Surgeries
Even after a successful replantation, some additional surgery may be needed as the body and replanted part heal and better use of the part becomes possible. The more common post-surgery procedures include:
- Tenolysis - Surgery to reduce or eliminate scar tissue from around the tendons
- Capsulotomy - Surgery to free up joints that have become stiff or locked in place
- Transfer of Muscles or Tendons - Muscles or tendons may be moved to a place where they are more needed
- Nerve Grafting - Gaps in the nerves or scarred nerves that work ineffectively may need replacement
- Late Amputation - If the replanted part doesn't work, keeps the hand from working, or causes pain, it may need to be removed.