What is Replantation of Amputated Digits?

Replantation of digits is a surgical procedure to reattach fingers or toes that have been cut off (amputated). Replantation of an amputated part is usually performed within 4-6 hours after injury. The success rate has been reported up to 24 hours after the injury if the amputated part has been cooled.

The goal of replantation surgery is to reattach and restore function to as much of the injured part as possible. With the help of microsurgical techniques, replantation has become more common and can be performed with success both aesthetically or cosmetically, and functionally.

Replantation of amputated parts is performed in amputated fingers, ears, forearms, hands, feet, avulsed scalp injuries, amputated lips, an amputated face, amputated penis, and even an amputated tongue.

What is Replantation Surgery used for?

Replantation is often performed for:

Traumatic amputations
Sharp and guillotine-type injuries (an amputation without closure of the skin)
Severe crush injuries
Mine blast injuries

Replantation is done to restore musculoskeletal and neurovascular integrity and to maintain function for aesthetic as well as cosmetic purposes.

Indication and Contraindication for Replantation Surgery

The following are the indications for replantation:

Amputations in children
Multiple fingers and hand amputations
Thumb amputation
Single finger injuries
Ring avulsion injuries

Contraindications to replantation include:

Severe crush injuries
Warm ischemia for a longer time, especially of muscle
Severe contamination
Life-threatening injuries

Book an appointment with Dr. Nilesh Satbhai to find out if you are the right candidate for reimplantation surgery.

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What to expect during a Replantation Surgery consultation?

During the replantation surgery consultation, Dr. Nilesh Satbhai will assess your injury. Dr. Nilesh will also ask about your medical history and conduct a physical examination. This is to confirm your wellness for the surgery. Dr. Nilesh will also go over the replantation process, including potential hazards and benefits.

How is Replantation Surgery performed?

Replantation surgery is done the following way:

General anesthesia or regional anesthesia (spinal and epidural) will be given to numb the arm or leg; this means you will be asleep and won’t feel any pain.
Dr. Nilesh will remove the damaged tissue, and the ends of the bones will be trimmed to make them smooth.
Then Dr. Nilesh will place the toe or finger (which is called the digit) in place. The bones are rejoined with the use of wires or a plate and screws. This holds the part in place and allows the rest of the tissues to be restored.
Followed by nerves and blood vessels, tendons are repaired. Nerve and blood vessel repairing plays the most important step for the better success of this procedure. If needed, tissue with healthy nerves and blood vessels from another part of the body is used.
The wound is now closed with stitches and bandages.

What is the success rate of Replantation?

The general success rate of limb replantation is about 83.3%. The type of injury plays an important role in determining the outcome of the treatment. For example, guillotine amputations (amputation performed without closure of skin) have a finer prognosis than crush amputations.

Factors that play an important role in outcomes are:

Age of the patient
Presence of multiple levels of injury
Injuries mechanism
Ischemia time
Medical conditions like hypertension, diabetes, and autoimmune diseases

Additional surgeries that are needed post replantation may include:

Tenolysis: To remove adhesions that are caused by scar tissue
Capsulotomy: To release stiff or locked joints
Tendon or muscle transfer: Relocating a functioning tendon or muscle
Nerve grafting: Replacement of a scarred or damaged nerve with a section of a healthy nerve (removing the healthy nerve from another part of the body)
Late amputation: Removal of the body part afterward due to severe pain and non-functionality.

How early does Replantation need to be done?

As per the ACSC (American College of Surgeons Committee), vascular injuries should be treated within 6 hours of the injury to increase the success rate of replantation.

The maximum time for a better outcome of replantation depends on two factors:

Body part involved: Parts that do not involve major muscle groups like fingers should be replanted within 12 hours (i.e., maximum ischemic time tolerated), whereas parts that involve major muscle groups like the legs or arms should be replanted within 6 to 8 hours for favorable limb salvage.
Ischemic time: Surgery is not performed if the warm ischemia time is beyond 6 hours and the cold ischemia time is beyond 12 hours.
- Warm ischemia time refers to the time a tissue or a part of your body remains at normal body temperature after the blood supply is minimized or cut off but before it is cooled down or is connected again to a blood supply.
- Cold ischemia time usually means the time between the chilling of your body part or tissue after its blood supply is minimized or cut off and the time it is warmed again by restoring its blood supply.

Recovery and post-operative care for Replantation Surgery

Dr. Nilesh will take special care of you while you are in the hospital to make sure your blood flows properly to the part that is reattached. The part which is reattached (arm or leg) will be kept raised for better blood flow. The room may be kept at a warm temperature to ensure proper blood flow to the treated part. The reattached part will be checked often to ensure there is a good flow of blood.
After you are discharged from the hospital, you may need to wear a cast to protect the replanted part. Your surgeon Dr. Nilesh may prescribe you some blood-thinning medicines such as aspirin, to prevent blood clots.
Generally, you should avoid smoking, as it might cause loss of blood flow to the replanted part.
Keep the replanted part elevated for better blood flow.
Braces are used to protect the newly repaired tendons and allow the patient to move the replanted part.
Physical therapies also play an important role in recovery.
Emotional recovery - When your bandages are removed, you see the replanted part for the first time, and you may feel disappointment or disbelief, anger, or grief because the body does not look like it did before. These feelings are common, and talking to your doctor about these feelings often helps you to come to terms with the outcomes.

Follow-ups

You will be set up for follow-up visits with Dr. Nilesh . The first follow-up is usually after 2 or 3 weeks.
Depending upon your recovery rate, Dr. Nilesh will change your medication or say to continue with the previous one for some time.
You will get instructions on your dietary sources as per your day-to-day activities.
You will be advised for further timely follow-ups by Dr. Nilesh .

What is the cost of Replantation Surgery in Mumbai?

The cost of replantation surgery in Mumbai will depend on various factors, such as the type of the severity of the condition and the procedures involved. During your consultation, Dr. Nilesh Satbhai will guide you with a thorough cost estimate for your replantation surgery.

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What are the potential complications/risks of Replantation?

For most patients, it takes almost 6-12 months for the replanted body part to heal properly with the help of physical and rehabilitation therapy. Improper care can cause complications such as infection or inflammation, significant loss of blood, venous or arterial thrombosis, restricted range of motion, and muscle stiffness affecting mobility and flexibility. If any of these complications occur, Dr. Nilesh Satbhai will take the necessary steps to treat the problem effectively.

Prognosis

Children are healthier candidates for replantation surgery because they have a greater ability to heal and regrow tissue.
Replantation of an amputated part is done within 6 hours after the injury. But it can still be successful if the amputated part has been cooled for up to 24 hours after the injury.
You will not have the exact same flexibility in the finger or toe or the part that has been replanted after surgery. Pain and sensation changes may continue for some time.

Repair Amputated Digits With Replantation Surgery in Mumbai

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Meet the Doctor

MBBS, MS, MCh

Dr. Nilesh Satbhai is a highly experienced and skillful plastic surgeon who has dedicated his career to helping patients feel at ease with their bodies. He completed his Plastic Surgery training at the prestigious Seth G. S. Medical College and K.E.M Hospital in Mumbai, after which he went on to earn his fellowship in various subfields of plastic and reconstructive surgery. Dr. Nilesh is a caring professional who takes the time to get to know his patients and understand their individual needs and goals. He is committed to providing the highest quality care possible and strives to make every patient feel comfortable and confident in their decision to undergo treatment. If you are considering plastic or reconstructive surgery, Dr. Nilesh Satbhai is a trusted surgeon who can provide you with the results you desire.