What Is Replantation?
The process of surgically rejoining a body part separated from the body, like a finger, hand, or toe, is known as replantation. Replantation aims to reattach and restore as much of the damaged portion as feasible. A lost bodily part may not always be able to be planted again for a variety of reasons. A patient may need a prosthesis that replaces a missing body part if the lost portion cannot be reattached. A prosthesis may improve a person's functionality and standard of life.
Replantation is usually advised when the replanted portion performs at least as well as a prosthesis. An index finger, for instance, would not be reattached by a surgeon if it was thought that the finger would be uncomfortable, numb, and stiff and interfere with the other fingers' function. Surgeons may choose to reattach a thumb, however, recognizing that this vital digit would be preferable to a prosthesis in the event of a successful replantation. The physician will give a preoperative explanation of the process and the expected functional recovery after replantation. The patient or a family member must determine whether regaining the use of the bodily part is worth the lengthy and painful procedure, hospital stay, and months or years of rehabilitation.
Replanting is, unfortunately, a time-sensitive process. Therefore, choices need to be made quickly and effectively. It is crucial to remember that replantations are extremely complicated operations that are limited to specialized facilities. Furthermore, as was already said, even if the patient or family may very much want it, replantation is only sometimes viable.
How Is Replantation Surgery Performed?
The replanting procedure involves multiple processes and usually requires several hours to complete.
-
Initially, the surgeon surgically cleans the portion and the stump of any diseased or contaminated tissue.
-
The surgeon then trims the ends of the bones. Trimming the ends before rejoining them makes connecting the soft tissue on both sides of the wound easier.
-
After that, the surgeon fixes the muscles and tendons, usually in a way that enables the patient to use the affected portion as soon as possible after healing.
-
The surgeon next performs the microsurgery to link the veins, arteries, and nerves. This requires talent, patience, and precise technique and is frequently the most difficult component of the case. Whether an element can survive surgery depends on the state (condition) of the vessels. Blood vessels may become permanently damaged as a result of excessive trauma, rendering the component's ability to transport blood to and from become impossible. This would cause the replantation to fail. The doctor performing the surgery can advise against trying the replantation if they have doubts about the quality of the vasculature in the portion of the stump.
-
After the treatment, the surgeon closes the skin loosely to prevent the freshly restored blood arteries from being compressed. In certain cases, the surgeon may need to remove skin or other tissue from the patient's healthy portions to cover any exposed areas on the replanted portion. This can be done immediately after the replanting or a few days or weeks later.
How Does Recovery Occur?
Following a successful transplant, the patient often remains in the hospital for a week or more.
-
The replanted portion is continuously watched to check that it survives the surgery.
-
During injury, surgery, and recovery, patients frequently lose a significant amount of blood, necessitating blood transfusions (donor blood given to the patient).
-
Following surgery, the patient typically takes blood thinners to avoid clots in the repaired veins, which can result in more blood loss.
-
Laboratory tests (blood tests) are performed daily to ensure that the patient's blood counts are within safe bounds.
-
The room has to be kept warm to prevent blood vessel spasms.
-
Patients frequently cannot consume caffeine and other foods and drugs that may induce vascular spasms.
-
Elevating the extremity facilitates blood flow from the recently joined area.
-
Leeches may be administered to the replanted component following surgery to aid vascular recovery. Replantation may not be successful if blood enters the area through the arteries but does not exit the area through the veins efficiently. To allow fresh, oxygenated blood to pass through and to maintain the tissues alive, leeches aid in thinning the blood and pulling old blood out of the affected area.
-
The patient may begin therapy to move the transplanted portion and prevent tendon adhesions, which are bands of scar-like tissue. It indicates that the transplanted portion has a good chance of survival.
-
The regeneration of both motor and sensory nerves is frequently necessary for complete recovery. Sensory nerves convey information from various body regions to signal pain, pressure, and temperature to the brain. Motor nerves convey signals from the brain to muscles, causing the body to move.
-
Only sensory nerve recovery is required in a finger replantation because the muscles responsible for controlling the finger reside in the hand and forearm and are not normally affected by the amputation.
-
Motor nerves must heal for the hand, wrist, or elbow to move after a hand or arm replantation.
-
Nerves grow roughly an inch per month, which helps doctors predict how long recovery will take. After an amputation, nerves rarely regain their entire range of function. Even though some motor function and sensation recover, the replanted portion will never work the same as before the damage.
Conclusion
The replanted component will never be completely functional again. Most clinicians regard 60 to 80% to be an excellent result. In general, individuals without joint injuries will regain more range of motion than people with injuries do. Younger patients have a higher probability of regaining their nerves than adults. They may regain increased movement and sensation in the replanted area.
