Conditions & Treatments

Replantation Surgery

What is

Replantation Surgery?

“Replantation” refers to the surgical reattachment of a finger, hand, or arm that has been completely cut from a person’s body. The goal of replantation surgery is to give the patient back as much use of the injured area as possible.

In some cases, replantation is not possible because the part is too damaged. If the lost part cannot or should not be reattached, you may have the alternative of an amputation with or without a prosthesis, a device that substitutes for a missing part of the body. In some cases, this option will give you better and faster recovery than a replantation.

Replantation is usually recommended when the replanted part will work at least as well as a prosthesis. Generally, a missing hand or finger would not be replanted knowing that it would not work, be painful, or get in the way of everyday life.

Before surgery, the doctor will, if possible, explain the procedure and the substantial commitment of time and effort needed from the patient for recovery, as well as how much use is likely to return following replantation. The patient and/or family members must decide whether that amount of use justifies the long and difficult operation(s), time in the hospital, and months or years of rehabilitation.

Steps of

the Procedure

There are a number of steps in the replantation process. First, damaged tissue is carefully removed. Then, bone ends are shortened and rejoined with pins, wires, or plates and screws. This holds the part in place to allow the rest of the tissues to be restored to a normal position.

Muscles, tendons, arteries, nerves and veins are then repaired. Sometimes grafts or artificial spacers of bone, skin, tendons, and blood vessels may be needed as well. The grafts can be from your own body or from a tissue bank.

Recovery after

Replantation

As the patient, you have a very important role in the recovery process.

Smoking causes poor circulation and may cause loss of blood flow to the replanted part. You can improve the blood flow to the replanted part by not smoking.

Allowing the replanted part to hang below heart level may also cause poor circulation.

Age plays a role in recovery. Younger patients have a better chance of their nerves growing back; they may regain more feeling and movement in the replanted part.

Generally, the farther down the arm the injury occurs, the better the return of use of the replanted part.

Patients who have not injured a joint will get more movement back than those with a joint injury. A cleanly severed part usually works better after replantation than one that has been pulled off or crushed.

Recovery of use depends on regrowth of two types of nerves: sensory nerves that let you feel and motor nerves that tell your muscles to move. Nerves grow about an inch per month. The number of inches from the injury to the tip of a finger gives the minimum number of months after which the patient may be able to feel something with that fingertip.

The replanted part never regains 100% of its original use, and most doctors consider 60% to 80% of use an excellent result.

Cold weather may be uncomfortable and be a cause of frequent complaints even for those with excellent recovery.

Therapy and

Rehabilitation

Complete healing of the injury and surgical wounds is only the beginning of a long process of rehabilitation.

Therapy and temporary bracing are important to the recovery process. From the beginning, braces are used to protect the newly repaired tendons but allow the patient to move the replanted part. Therapy with limited motion helps keep joints from getting stiff, helps keep muscles mobile, and helps keep scar tissue to a minimum.

Even after you have recovered, you may find that you cannot do everything you wish to do. Tailor-made devices may help many patients do special activities or hobbies. Talk with our hand surgeon to find out more about such devices.

Many replant patients are able to return to the jobs they held before the injury. When this is not possible, patients can seek assistance in selecting a new type of work.

Common Emotional Problems

after Replantation

Replantation surgery and amputation/prosthesis use can affect your emotional life as well as your body. When your bandages are removed and you see the replanted or amputated part for the first time, you may feel shock, grief, anger, disbelief, or disappointment because the body part does not look like it did before.

Worries about the appearance of a body part and how it will work are common. Talking about these feelings with the doctor often helps you come to terms with the outcome. The doctor may also ask a counselor to assist with this process. You may find it helpful to talk with someone about it and work through your feelings in order to lay the foundation for a more positive outlook.

Additional Surgeries &

Next Steps

After replantation surgery, some patients may need additional surgery at a later time to gain better function of the part.

Tenolysis

Tenolysis frees tendons from scar tissue.

Capsulotomy

A capsulotomy procedure releases stiff, locked joints.

Tendon or Muscle Transfer

In this type of procedure, tendons or muscles are moved to another spot so that they can work in an area that needs the tendon or muscle more.

Nerve Grafting

Nerve grafting replaces a scarred nerve or a gap in the nerves to improve how the nerve works.

Fusion

Fusion unites two bones across a joint that is damaged, merging them into a single bone.

Joint Implants

Joint implant procedures reconstruct damaged joint surfaces with materials that allow some motion.

Later Amputation

In some cases, it may be necessary to remove the part because it does not work well, interferes with use of the hand, or has become painful.

Even with the best medical care, you need to be strong during the course of recovery. Remember that you determine your own quality of life.

Make an appointment to see our hand surgeon in West Bloomfield, St. Clair Shores, Howell, or Macomb Township to see if replantation surgery is an option for you.

If you need urgent medical assistance, go to your nearest emergency room or call 911.

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Dr. Aroras office from my first call to schedule my appointment was friendly. Walking in the first day, I felt like I was in a nice atmosphere. Dr. Arora was EXCELLENT in taking great care of my hand injury. He was gentle and very understanding to the concerns I had about my hand. His expertise was admirable and I would recommend anyone with an injury to their hand to his office to be under his care. Because of him, I have healed faster than expected and will make an 100% recovery! Thank you Dr.

Jackie S.

I first thought I was going to have to have painful injections or surgery, but Dr. Arora suggested physical therapy may do the trick. I was doubtful, but I agreed to do it. Now, my pain is gone, and with the help of an ergonomic keyboard at work to keep my hands in the correct position, I am virtually pain free. The therapy strengthened my wrists and shoulders, and built more flexibility into my wrists.

Jerry T.

My experience with this doctor was positive from the outset. Dr. Arora was kind and spent a great deal of time with me. Staff was friendly. The office was nice and bright.

Ariel G.

Very friendly and helpful Great staff!!! Doctor Arora was very professional and did great work. I was very happy with everything!

L B.