Replantation is surgically reattaching a body part (such as a finger, hand, or toe) that has been completely cut from the body. The primary goal of replantation surgery is to attach and restore function of the injured part as much as possible.
Sometimes, replantation of a lost body part may not be possible because of the extent of damage. If the lost part cannot be reattached, a patient may need to use a prosthesis, a device that substitutes for a missing part of the body. In some cases, prosthesis may give a person without hands or arms an ability to function.
Replantation is usually recommended when there is a probability that the replanted part will work at least as well as a prosthesis. For example, a surgeon would not reattach a missing hand knowing that it would not work, be painful, or get in the way of the patient’s everyday activities.
Before performing surgery, the doctor will explain the procedure and how much function is likely to return following replantation. The patient or family members must decide whether regaining use of the body part justifies the long and difficult operation, time spent in the hospital, and months or years of rehabilitation.
There are a number of steps in a replantation procedure. First, the damaged tissue is carefully removed. Then, bone ends are trimmed before they are ready to be rejoined. This makes putting the soft tissue together on either side of the wound easier.
The arteries, veins, nerves, muscles, and tendons are stitched together. Uncovered nerves, tendons, and joints may be covered by a free-tissue graft or transfer, where a piece of tissue is removed from another part of the body, along with its arteries and veins.
This is a very time-consuming process and requires a meticulous and very specialized approach. Dr. Chandan Nag Choudhury specializes in microvascular surgery as well and thus, the expertise he brings is a complete package for a successful replantation surgery
Finally, areas without skin are covered with skin that has been taken from other areas of the body (donor area).
Recovery of function and use depends on re-growth of two types of nerves: sensory nerves and motor nerves. Sensory nerves carry messages to the brain from various parts of the body to signal pain, pressure, and temperature. Motor nerves are responsible to carry messages from the brain to muscles to make the body move.
Nerves generally grow about an inch per month, and this fact helps doctors estimate the time it may take for recovery. For instance, in a fingertip injury, the number of inches from the injury to the tip of a finger provides an estimate of the minimum number of months, and only after that the patient may begin to feel something with that fingertip.
Physical Therapy and Rehabilitation
Complete healing of the injury and the surgical wounds are only the first steps of a long process of rehabilitation. Physical therapy and temporary bracing are important to the recovery process.
Braces are used from the beginning to protect the newly repaired tendons and to allow the patient to safely move the replanted part. Physical therapy exercises are used to prevent the joints from becoming stiff, to keep the muscles moving, and to minimize the formation of scar tissues.
Even after a full recovery, re-plantation patients may find that they cannot do everything they wish to do or did before the injury and surgery. Custom-made devices allow many patients to do special activities or hobbies. A physician or therapist can provide more information about such devices.
Many re-plantation patients are able to return to their jobs they held before the injury. When this is not possible, patients are suggested to seek assistance in selecting a new type of work.
The Patient’s Role in Recovery
The patient has an important role in their recovery process. Smoking causes poor blood circulation that may result in a loss of blood flow to the replanted part. Also, if the injury has occurred in the hand, then allowing the replanted part to hang below heart level for extended periods of time may also cause poor circulation to the replanted part and delay recovery.
Emotional Aspects of Recovery
Replantation can affect a patient’s emotional life along with their body. When their bandages are removed, a patient may feel shock, grief, anger, disbelief, or disappointment because the replanted part may not look like it did before. Worries about the look of a replanted part and how it will work are common. Talking about these feelings with the doctor helps many patients come to terms with the outcome of their re-plantation. The doctor may also ask a counselor to assist with this process.
My Message to Those recovering
During recovery, it is important to stay in the flow of life. You have many great gifts. Along with the best medical care, you need to be mentally very strong during the course of recovery. Remember that quality of life is directly linked to your attitude and expectations, not just regaining limb use.
When Additional Surgery may be Needed
Some patients who have fully recovered from replantation surgery may still need additional surgery to regain full use of the part. Some of the most common procedures are:
· Tenolysis: frees tendons from scar tissue
· Capsulotomy: releases stiff, locked joints
· Tendon or muscle transfer: To move tendons or muscles to an area that needs the tendon or muscle more
· Nerve grafting: replaces a scarred nerve or a gap in the nerves to improve how the nerve works
· Late amputation: removal of the part later because it may not work or has become painful
The replanted part never regains 100% of its original use and 60% to 80% is considered to be an excellent result. Generally speaking, patients who have not injured the joint are likely to get more movement back than those who have. A cleanly cut part usually works better after replantation than one that has been crushed or pulled off.
Younger patients have a better chance of nerve re-growth when compared to adults. They may recover more sensations and may regain more movement in the replanted part.
Cold weather can be uncomfortable and painful for patients with replanted body parts. It is a frequent long-term complaint, even in those with excellent recovery.
Thank you for reading.
— Dr. Chandan Nag Choudhury, Hand and Foor Replantation Surgeon, Guwahati, Assam
You may connect with Dr. Chandan Nag Choudhury for any query, concern, or consultation.