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Replantation is a complicated procedure that can take 18-24 hours to perform
Replantation involves surgically reattaching a finger, hand, or arm that has been severed from the body. Replantation is a complicated procedure that can take 18-24 hours to perform.
How soon does replantation need to be done?
According to the American College of Surgeons Committee on Trauma, vascular injuries should be treated within 6 hours of the injury to maximize the success of replantation.
The maximum time in which replantation should have be done for a better outcome depends on two factors:
- Body part involved: Parts not involving major muscle groups such as the fingers should be replanted within 12 hours (maximum ischemic time tolerated), whereas parts involving major muscle groups such as the arms or legs should be replanted within 6-8 hours for successful limb salvage.
- Ischemic time: Surgery is contraindicated if warm ischemia time exceeds 6 hours and cold ischemia time exceeds 12 hours.
- Warm ischemia time indicates the time a tissue or body part remains at body temperature after the blood supply is reduced or cut off but before it is cooled or reconnected to a blood supply.
- Cold ischemia time indicates the time between the chilling of a tissue or body part after its blood supply is reduced or cut off and the time it is warmed again by having its blood supply restored.
What is replantation surgery used for?
Replantation is often performed in response to:
- Traumatic amputations
- Sharp, guillotine-type injuries (an amputation without closure of the skin)
- Severe crush injuries
- Mine blast injuries
Replantation is done to restore neurovascular and musculoskeletal integrity and maintain function, as well as for aesthetic or cosmetic purposes.
Chances of a successful replantation are improved if the amputated body part is preserved as soon as possible in a cool (close to freezing but not at or below freezing temperature) and sterile environment.
What is the success rate of replantation?
The overall success rate of limb replantation is approximately 83.2%. The type of injury plays a key role in determining the outcome. For example, guillotine amputations have a better prognosis than crush amputations.
Factors that play a vital role in outcomes include:
- Patient age
- Presence of multiple levels of injury
- Mechanism of injury
- Ischemia time
- Medical conditions such as diabetes, high blood pressure, and autoimmune diseases
Additional surgeries needed post replantation may include:
- Tenolysis: To remove adhesions caused by scar tissue
- Capsulotomy: To release stiff or locked joints
- Tendon or muscle transfer: Relocation of a functioning tendon or muscle
- Nerve grafting: Replacement of a damaged or scarred nerve with a section of a healthy nerve that has been removed from another part of the body
- Late amputation: Removal of the body part later on due to pain and non-functionality
What are potential complications of replantation?
For most patients, it takes approximately 6-12 months for the replanted body part to heal completely with the help of physical and rehabilitation therapy. Improper care can cause complications such as:
- Infection
- Significant blood loss
- Venous or arterial thrombosis
- Restricted range of motion
- Muscle stiffness affecting mobility and flexibility