Finger reattachment, or replantation, is a specialized surgical procedure to rejoin a finger completely severed from the hand. This procedure aims to restore the finger’s function and appearance. Modern medicine has made it possible to reattach amputated digits in many cases.
The Possibility of Reattachment
Reattachment of a severed finger is possible through replantation, representing an advancement in reconstructive surgery. This procedure involves reconnecting tiny structures within the finger. Microsurgery, using powerful operating microscopes and specialized instruments, allows repair of structures like blood vessels and nerves. The goal is to restore blood flow, sensation, and movement to the injured digit. Without microsurgical precision, reconnecting the minute arteries, veins, nerves, tendons, and bones necessary for the finger’s survival and function would not be possible.
Immediate Actions After Injury
Immediate and proper handling of an amputated finger is important for reattachment success. The initial steps involve controlling bleeding from the injured hand and preserving the severed part. Direct pressure should be applied to the stump to stop bleeding, and the injured hand should be elevated above the heart to reduce swelling.
The amputated finger should be gently rinsed with clean water or sterile saline, but not scrubbed. After rinsing, it should be wrapped in a clean, damp gauze or cloth and placed into a sealed, waterproof plastic bag. This bag should then be placed into another container filled with ice water, ensuring the severed part does not directly contact the ice, as direct contact can cause further tissue damage.
Seek immediate emergency medical attention. The time between injury and medical care significantly influences reattachment success.
The Replantation Procedure
Finger reattachment surgery is a complex, multi-hour operation performed by specialized surgeons. The process begins with removing damaged tissue from both the severed finger and the stump. Bone ends are trimmed and reconnected using pins, wires, or plates and screws for stabilization.
Once stabilized, surgeons repair the tendons, which enable finger movement. Next, tiny arteries, veins, and nerves are reconnected using microsurgical techniques. Re-establishing blood flow through these vessels is essential for the finger’s survival. Finally, the skin is loosely closed over the repaired structures to avoid compressing the blood vessels.
Factors Determining Success
Several factors influence successful finger reattachment and functional outcome. The type of injury is important; clean-cut amputations, like those from sharp objects, have a better prognosis than crush or avulsion (tearing) injuries, which cause extensive tissue damage. The amputated part’s condition and preservation before surgery are also important. The time the finger is without blood supply, known as warm ischemia time, is a factor. Patient health, age, and smoking status impact success rates, with younger patients having a better chance of nerve regrowth and recovery.
Post-Surgical Recovery and Outcomes
Recovery after finger reattachment surgery is a prolonged process. Post-operative care involves monitoring blood flow to the reattached part, keeping the arm elevated and the room warm to aid circulation. Physical and occupational therapy are essential for rehabilitation, starting with gentle exercises to promote blood flow and prevent stiffness.
Rehabilitation progresses to exercises improving finger strength, flexibility, and fine motor skills. While the goal is to restore as much function as possible, a replanted finger may not regain 100% of its original use. Long-term outcomes can include stiffness, altered sensation, cold intolerance, and the need for additional surgeries to address complications like scar tissue or nerve issues.