What is Finger Replantation?
Finger replantation is a surgical procedure used to reattach a finger that has been completely severed from the hand. It is a highly specialized procedure requiring expertise in microsurgery and reconstructive techniques and may take several hours to perform. The success of the procedure depends on several factors, including the time elapsed since the injury, the condition of the severed finger and hand, and the patient's overall health. The goal of the surgery is to restore as much function and appearance as possible to the reattached finger.
Indications for Finger Replantation
Finger replantation is typically indicated in cases where the finger has been cleanly severed with minimal damage to surrounding tissues, such as from a sharp object like a knife or glass or while operating machinery. Candidates who are in good health and highly motivated to undergo extensive rehabilitation post-surgery may be considered for replantation.
Contraindications include severe contamination of the severed finger, crush or avulsion injuries where the tissue damage is extensive, prolonged time between amputation and surgical intervention (typically more than 12 hours for digits, though this can vary), and certain patient conditions such as uncontrolled diabetes or vascular diseases that impair healing.
Preparation for Finger Replantation
In general, preparation for finger replantation may include the following:
- The severed finger is cleaned, wrapped in a sterile saline-soaked gauze, and placed in a sealed plastic bag, which is then kept on ice.
- The patient's hand and severed finger are assessed for viability. Fingers should typically be replanted within 12 hours (maximum ischemic time tolerated).
- Perform X-rays or other imaging studies to assess bone and soft tissue damage.
- Perform blood tests to assess the patient's overall health and prepare for possible blood transfusions.
- Administer antibiotics to prevent infection.
- Provide tetanus prophylaxis if needed.
- Control bleeding and administer pain management.
- Obtain informed consent from the patient or their guardian.
Procedure for Finger Replantation
In general, the procedure for finger replantation may include the following steps:
- Anesthesia: The patient is given general anesthesia or regional anesthesia, depending on the case.
- Debridement: Both the severed finger and the remaining hand stump are cleaned and debrided to remove any contaminated or non-viable tissue.
- Bone Fixation: The bones are aligned and fixed using wires, pins, or small plates and screws to provide stability.
- Tendon Repair: Flexor and extensor tendons are meticulously sutured together to restore finger movement. This is done using fine, non-absorbable sutures.
- Vascular Repair: The arteries and veins are reconnected under a microscope using microsurgical techniques to restore blood flow. This step is critical for the survival of the reattached finger.
- Nerve Repair: The digital nerves are reconnected to restore sensation to the finger, using fine sutures and a microscope for precision.
- Skin Closure: The skin is carefully sutured to close the incision. Skin grafts or flaps may be needed if there is significant skin loss.
Postoperative Care and Recovery
In general, postoperative care and recovery for finger replantation may include the following:
- The hand and reattached finger are immobilized using a splint or cast to protect the surgical site. Immobilization typically lasts for several weeks.
- The patient is closely monitored for signs of vascular compromises, such as changes in color, temperature, or swelling of the reattached finger. Doppler ultrasound may be used to assess blood flow.
- Pain medications are provided, and antibiotics are administered to prevent infection.
- A structured rehabilitation program is started after the initial healing period, involving physical and occupational therapy to restore movement, strength, and function.
- Full recovery may take several months to over a year, and some patients may not regain full function or sensation.
- Follow-up visits are scheduled to monitor healing and address any complications.
Risks and Complications
Risks and complications of finger replantation surgery include:
- Infection
- Vascular compromise
- Nerve damage
- Joint stiffness and tendon adhesions
- General anesthesia risks
