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Replantation of digits

  • Definition
    • Replantation of digits is surgery to reattach fingers or toes that have been cut off (amputated).

  • Alternative Names
    • Revascularization of amputated digits; Reattachment of amputated fingers

  • Description
    • This procedure is done using regional or general anesthesia. The ends of the bone may be shortened to remove tension on the repaired blood vessels. The surgeon places the finger or toe (called the "digit") in place and stabilizes the bone with wires or a plate and screws.

      Tendons are repaired next, followed by nerves and blood vessels. Nerve and blood vessel repair is the most important step to the success of the procedure.

      After all repairs are complete, the wound is closed and a bandage (called a bulky dressing) is applied. Young children may need to wear a cast to protect the area from injury.

      If you have a partial (incomplete) amputation, part of the toe or finger stays attached to the body by skin, an artery, vein, or nerve. In this case, a process called revascularization is used to reattach the finger or toe. The blood vessels need to be reattached to allow the partially amputated limb to live.

  • Why the Procedure Is Performed
    • The surgery is done when fingers or toes have been amputated, and are in a condition that would allow replantation.

  • Risks
    • Risks of this surgery include:

      • Reactions to medications
      • Problems breathing
      • Bleeding
      • Infection
      • Death of the replanted tissue
      • Reduced nerve function or movement in the replanted digit
      • Stiffness of the fingers
      • Pain that continues after surgery
  • After the Procedure
    • Special care will be taken while you are in the hospital to make sure blood flows properly to the reattached part. The arm or leg will be kept raised. The room may be kept warm to ensure proper blood flow. The reattached part will be checked often to make sure there is good blood flow.

      After you are released from the hospital, you may need to wear a cast to protect the finger or toe.

      Proper care of the amputated part or parts is very important to successful replantation. Under the right conditions, there is a good chance that the surgery can restore the use of the finger or toe. You will need follow-up visits with your health care provider, who will continue checking blood flow in the surgery area.

  • Outlook (Prognosis)
    • Children are better candidates for replantation surgery because of their greater ability to heal and regrow tissue.

      Replantation of an amputated part is best done within 4 to 6 hours after the injury. But replantation can still be successful if the amputated part has been cooled for up to 24 hours after the injury.

      You will not have the same flexibility in the finger or toe after surgery. Pain and sensation changes may continue.

  • References
    • Goldner RD, Urbaniak JR. Replantation. In: Wolfe SE, Hotchkiss RN, Pederson WC, Kozin SH, eds. Green's Operative Hand Surgery. 6th ed. Philadelphia, PA: Elsevier Churchill Livingston; 2010:chap 48.

      Gross KR, Collier BR, Riordan WP Jr., Morris JA Jr. Wilderness trauma and surgical emergencies. In: Auerbach PS, ed. Wilderness Medicine. 6th ed. Philadelphia, PA: Mosby Elsevier; 2011:chap 21.

      Morell D. Management of amputations. In: Roberts JR, Hedges JR, eds. Clinical Procedures in Emergency Medicine. 6th ed. Philadelphia, PA: Saunders Elsevier; 2013:chap 47.