Replantation – Giving Hope To Patients For Their Amputated Limbs

Reimplantation involves joining back in its position and cut a part of the body. this is often 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 reimplantation in Amritsar. this is often 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 got to be wrapped during a damp cloth/gauze, placed during a bag, then the bag placed in an icebox. The part should never be placed directly on ice, nor should it’s placed in water or other liquid. Pressure should be applied to the amputated stump employing a clean cloth or pressure dressing, wherever possible. Patients should be brought as soon as possible to the closest tertiary care Centre where microsurgery is performed.

What actually is completed once you reach the hospital?

The part is taken to the operation theatre to be washed and examined under a microscope. it’s doing to be replaced. within the meantime, the patient is investigated, i.e., basic blood tests are done, adequate blood arranged as needed. The need for blood depends on the part amputated. Then the patient is shifted to the operation theatre. All the cut structures are stitched back onto 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 completed and splint where applicable.

What are the chances of success?

The chance of success depends on various factors like:

However, the common steps involved within the process include:

• Mode of injury: a pointy cut features a far better chance than a crush or avulsion injury. Avulsion may be a process of the part being suddenly pulled out or twisted out, like just in case of washer injury.
• Smoking: the patient who smokes regularly features a higher chance of failure than a nonsmoker.
• Multiple level injury: generally outcomes are poor and hence reimplant not attempted.
• Co-morbidities like diabetes, vascular diseases – 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 an increased pain killer dose.

In every case of reimplantation, there’s a risk of the repaired blood vessels getting blocked any time after surgery, most ordinarily within the 1st – 3rd days post-surgery. an in-depth watch is going to be kept by the surgeons and specialized staff and if such a drag is noticed, a patient may have to be taken to the OT to correct the matter.

Normally a patient is discharged on the 5th – 7th-day post-surgery. The dressing may or might not be changed before discharge.

Recovery After Replantation

In cases of hand replantation, physiotherapy is started after one month under professional supervision at the hospital. The splint will remain in situ for two months, strengthening exercises will start after 2 months, and normal activities after 3 months. Return of sensation happens in a few years, counting on the world 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 outcomes and survival.

Physiotherapy– in cases of hand and foot reimplant, regular physiotherapy is important to urge an honest 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 an increased chance of infection.

A lot of patients do require secondary surgery for improvement of function.

What to expect from Replantation of Amputated Parts?

It is impossible to regain 100% of the pre-injury functional status of the patient. After reimplantation of the amputed limbs, a return of 60-70% function is often considered as a superb result, In cases of isolated fingers, the functional outcomes are often better. It varies depending upon the part amputated, the sort of amputation, age of the patient, nutritional status, and the way much he/she follows the exercise protocol.