Hand Replantation Surgery.
Last updated Wednesday, February 09, 2005
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About replantation surgery
Microsurgery advances
Remarkable advances in microsurgery have made it possible to reattach
amputated limbs. Special microsutures and microscopes have been
developed which allow a microvascular surgeon to repair the blood
supply to the reattached limb. Microvascular surgeons have developed
new techniques for repairing these very small blood vessels. These
surgeons, originally trained in orthopedic, plastic and general
surgery, receive additional training in this highly specialized area.Recovery and reattachment
The sudden loss of a finger or hand can be a devastating injury. But
with emergency surgery by trained microsurgeons, dramatic recovery of
the use of one's hand is possible. Reattachment of amputated fingers or
hands requires emergency surgery. This surgery is complicated and the
recovery time is long. Patients should discuss the specifics of the
surgery with their physicians.Pre-surgical factors
Several pre-surgical factors may increase or decrease the possibility for successful replantation surgery.
The severity of the injury can affect what parts of the hand or fingers are able to be saved.
Cooling the amputated part can substantially increase the time that
can elapse between injury and surgery. When preparing patients for
transfer to a replantation center, emergency medical personnel will
package the amputated limb or digits on ice in order to optimize the
chance for successful replantation.
A key factor in improving the success for patients with finger and
hand amputations is the emergency hospital network. This includes rapid
transportation by ambulance or air. Emergency technicians arrange for
transportation and insure that bandages, X-rays, antibiotics,
intravenous fluids and tetanus shots are provided rapidly.
There are several factors involved in the decision to surgically replant an amputated digit or limb.Delay of surgery
Surgery may not be possible when there has been a delay in reaching
treatment. This can happen when patients have been hurt in remote areas
or when other emergency medical treatment delays surgery to re-attach
the amputated limb.Age of patient
Because the surgery can take many hours, the stresses of anesthesia and
vascular changes such as hardening of the arteries may substantially
increase the risks of the procedure for the older patient and decrease
the chances for replantation success.Type of injury
Crush injuries require the removal of all damaged tissue surrounding
the injury. This can be extensive. Surgeries involving crush injuries
have a much lower rate of success, with less chance of survival of the
replanted digit or hand and less recovery of function, as compared to
sharp injuries.
Foot and leg replantations are indicated only in special
circumstances where a very sharp injury has occurred. it may be
neccessary to remove a significant amount of damaged tissue at the site
of amputation. Walking can be difficult when the foot or leg is
shortened because of tissue removal. Some patients, following limb
amputation, will not be able to walk or run until an artificial leg has
been fitted.
Length of surgery
Surgery may last between 4 and 24 hours. Longer operations are
necessary when multiple individual digits have been amputated. The
surgery is frequently done with several operating teams. This decreases
the overall surgery time needed.About the surgery
Before surgery the patient' s injuries are cleaned very carefully to
avoid deep infection. Any fractured bones are stabilized first, using
small pins or metal plates. Next the tendons are repaired.
Repair of the delicate nerves, arteries and veins is done in the
last stage of the procedure. These repairs are performed under
operating microscopes, using microsurgical techniques.
In severe injuries, vein or skin grafts are taken from another site,
such as the forearm, foot or thigh. Vein grafts help to replace missing
segments of arteries or veins. Skin grafts are necessary when the
injury or swelling prevents the skin edges from closing.
Post-surgical care
Patients are watched closely for the first 48 hours. The patient's
room is kept very warm after surgery to keep blood vessels dilated and
to prevent blood clot formation.
Blood thinning medication is required for up to a week after
surgery. This medication prevents clot formation, a major cause of
replantation failure.
Smoking and drinking caffeinated beverages is restricted for three
weeks from the time of surgery. Smoking and caffeine can increase
chances of clot formation in the repaired vessels leading to failure of
the replant.
The hand or arm is wrapped in a bulky bandage for protection and to
decrease swelling. Before leaving the hospital, these bulky dressings
are often changed to a smaller bandage and splint.
Therapy to restore motion is started before leaving the hospital.
Check with your doctor about your overall recovery time.
Risks
Blood clot formation can prevent blood flow to the reattached limb.
To reduce the risk of blood clots, special blood thinning medications
are given.
Because multiple tendons and bones are frequently injured some loss
of motion (stiffness) occurs after all replantations. More severe
crushing types of injuries result in a greater degree of stiffness.