Replantation – Giving Hope To Patients For Their Amputated Limbs

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Reimplantation involves joining back in its position, any cut part of the body. This is a state-of-the-art microsurgical procedure increasingly being performed the world over now. In India, too, many such cases are being performed regularly at select institutes. Amandeep Hospital is one such premier institute performing reimplantations in Amritsar. This is made possible by good infrastructure and a well-trained team of plastic surgeons available around the clock.

What to do when a part is cut?

The part has to be wrapped in a damp cloth / gauze, placed in a plastic bag, and then the bag placed in an ice box. The part should never be placed directly on ice, nor should it be placed in water or any other liquid. Pressure should be applied to the amputated stump using a clean cloth or pressure dressing, wherever possible. Patients should be brought as soon as possible to the nearest tertiary care centre where microsurgery is performed.

• What actually is done when you arrive at the hospital?

  The part is taken to the operation theatre to be washed and examined under a microscope. It is made ready to be put back. In the meantime, the patient is investigated, i.e, basic blood tests done, adequate blood arranged as required. Need for blood depends on the part amputated. Then the patient is shifted to the operation theatre. All the cut structures are stitched back on to the cut stump. Bone is fixed using metal wires ( in cases of upper or lower limb replantation). Tendons required for moving the part ( where applicable) are repaired next. Microsurgical repair of the arteries veins and nerves is then done.

  An appropriate dressing is done and splint where applicable.

What are the chances of success?

Chance of success depends on various factors like:

However, the common steps involved in the process include:

• Mode of injury : a sharp cut has a much better chance than a crush or avulsion injury. Avulsion is a process of part being suddenly pulled out or twisted out, like in case of washing machine injury.
• Smoking : patient who smokes regularly has a higher chance of failure than a non smoker.
• Multiple level injury : generally outcomes are poor and hence reimplant not attempted.
• Co morbidities like diabetes , vascular diseases – these have poorer outcomes.

What to expect immediately after the surgery ?

IV fluids and medications to thin the blood will be given . There may be pain in the surgical site necessitating increased pain killer dose.

In every case of reimplantation, there is a risk of the repaired blood vessels getting blocked any time after surgery, most commonly in the 1st – 3rd days post surgery. A close watch will be kept by the surgeons and specialised staff and if such a problem is noticed, a patient may need to be taken to the OT to correct the problem.

Normally a patient is discharged on the 5th – 7th day post surgery. Dressing may or may not be changed prior to discharge.

Recovery After Replantation

In cases of hand replantation, physiotherapy is started after one month under professional supervision at hospital. Splint will remain in place for 2 months, strengthening exercises will start after 2 months and normal activities after 3 months. Return of sensation happens in about a year’s time, depending on the area of replantation.

Reimplants with fused joints have poorer functional outcomes than ones with intact joints.

The extent of recovery Depends on factors like:

• Patient age – younger patients have better outcomes than older.
• Smoker – non smokers have better functional outcome and survival.
• Physiotherapy- in cases of hand and foot reimplant, regular physiotherapy is essential to get a good outcome. If a patient fails to perform physiotherapy as advised, the reimplanted hand or finger may become stiff and non functional.
• Diabetes – diabetic patients take longer to recover with increased chance of infection.

Lot of patients do require secondary surgery for improvement of function.

What to expect from Replantation of Amputated Parts?

It is not possible to regain 100 % of pre injury functional status of the patient. After reimplantation of the hand, a return of 60-70% function can be considered as an excellent result, In cases of isolated fingers functional outcome can be better. It varies depending upon the part amputated, the type of amputation, age of patient, nutritional status and how much he/she follows the exercise protocol.[/vc_column_text][/vc_column][/vc_row]