What is Replantation?
Replantation is the surgical reattachment of a body part, most commonly a thumb, finger, hand or arm; that has been completely cut from a person's body. Though done less commonly, replatation of other body parts can also be done e.g. scalp, ear, face, penis, leg, foot and toes.
Replantation involves specialized skills and can be done by the Plastic and Reconstructive Surgeons specially trained in microvascular surgery.
The procedure involves fixing the bone, repairing cut muscles, tendons, nerves and blood vessels using specialized suturing techniques under operating microscope.
Favourable and unfavourable conditions for reimplantation :
Chances of succesful replantation depends to a large extent on the type of injury. A part amputated with a sharp object like knife, sword etc. has a better chance of being succesfully replanted than a part which has been crushd or pulled out. The decision, whether the amputated part can be replanted or not, is made by examining the part and the amputation stump by the operating surgeon in the emergency room.
If the patient has sustained severe injuries involving other systems like brain injury, injury to the chest or abdomen, replantation of amputated part may not be performed and instead life threatening conditions will need to be addressed.
How to preserve an amputated part?
The amputated part should be washed with water, wrapped in saline soaked gauze, put in a clean polythene bag which is sealed and placed in a container or another polythene bag containing ice. This keeps the amputated part cold and also avoids direct contact with ice which can cause direct damage to the part.
After the patient has been given first aid in the form of control of bleeding from amputation stump with direct pressure, he/she should be transported along with the persevered amputated part to the nearest centre with facilities for replantation.
After how many hours of amputation replantation is possible?
The duration for which the part can be preserved for replantation depends upon the level of amputation. Parts having no muscle, like fingers, can be preserved for much longer than parts having significant muscle bulk. When preserved cold as described above, immediately after the part has been severed from the body, fingers can be replanted upto 24 hours, whereas arm can be replanted upto 6-8 hours. In case part has not been preserved properly time period during which replantation is possible, gets reduced significantly.
In case of major amputation having significant muscle mass, replantation beyond 6 hours can even be life threatening. The decision to do the replantation or not is subjective and is taken by an experienced surgeon on an individual case bases.
Type of anaesthesia and duration of surgery :
Finger replantations can be performed by blocking the sensation to the hand. This is done by giving locacl anaesthetic at the arm pit region which blocks the nerves supplying the hand. Patient will be awake during the procedure. For major replantations involving the arm, general anaesthesia is preferred.
What can go wrong?
In such suregries, there is always a possibility of failure of replant in the first few days following surgery. This is due to blockage in the blood vessel which were repaired. In such cases , if another attempt to repair the vessel after clearing the block fails, the part may need to be removed and the wound simply closed. The chances of replant failure are more in amputated parts which are crsuhed or pulled out.
What to expect following replantation :
The part once cut, will never function normally as before the injury, even after a most succesful replantation procedure. This is a very important aspect which needs to be understood prior to consenting for the procedure. The surgery is just the beginning of a long period of treatment in which patient contributes as much to the success as does the treating surgeon. Regular, aggressive physiotherapy is a very crucial part of the post surgery treatment. Otherwise it can result into a non-functioning finger or hand. Hence, the patient needs to be ready for six months or more of aggressive physiotherapy.
Smoking needs to be strictly avoided from the time of surgery to better chance of a succesful replantation.
Replantation of leg :
This is rarely performed as leg is a muscular part and the injury is normally too severe to attempt a replant. It can be done in selective cases whn the injury is a sharp cut and the duration since amputation is less than 6 hours when part is cold preserved through out.