Replantation

Replantation

Replantation is the surgical reattachment of traumatically severed body part. If injury leading to amputation is relatively clean and produces only minimal tissue damage beyond the region immediately adjacent to the point of serence, replantation of the part may be possible.

Replantation may be entertained in amputation scenarios involving loss of the following:

1. The scalp

2. The ear

3. A finger (or fingers)

4. The hand

5. The foot

6. The arm

7. The leg

8. The penis

The complexity of the surgical endeavor, as well as the makeup of the surgical team devoted to its accomplishment, will depend upon the nature and level of the injury. Hence, repair of amputations 1-4 and 8 may involve only the plastic surgical team, while 5-7 may require participation from the orthopedic surgeon. Also, because so many amputation injuries occur in association with head, chest, and abdominal injuries of significance, the neurosurgeon and general surgeon will play a critical, life-saving role. Obviously, an institution must be set up to handle such crises as a matter of course, being able to quickly mobilize the critical hospital resources and man-power. Thus, replantation is not an undertaking appropriately pursued at every hospital.

Successful replantation begins in the field with proper care and transport of the victim and the severed part. The following protocol should be observed:

1. Rinse the severed part with saline or clean water
2. Do not scrub or dry the part
3. Wrap in one layer of dry sterile gauze or clean towel
4. Place in plastic bag and seal with tape
5. Place bag in second bag and immerse in ice
6. Do not submerge in water
7. Transport severed part in same conveyence as victim

This is the severed arm of a woman in her thirties.

This shows the arm after bony repair, and blood vessels and nerve repair. The muscle compartments have been opened to relieve the excess pressure which follows periods without circulation.

Here the patient is seen 2 years later, polishing her nails with the once-severed arm. Her function is not normal, but she is able to do many things with her replanted extremity.

Replantation is sometimes unsuccessful, and indeed, should not be attempted on every severed part. If the patient's other injuries are too severe, their treatment must take priority. Also, there are times when the minimal return of function which can be expected does not justify the surgery. For many, prosthetics and rehabilitation may prove a better alternative.

2/21/00

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