Finger replantation - What does that mean?

Our hands make us human, and each finger has its role in helping us through our lives. There are many ways to injure our hands, from small cuts to the most severe injuries - amputation. Amputation is when a part of our body is detached from us, and fingers are a common amputated part for us as humans. Surgery to connect us back with our detached fingers is called “replantation” surgery.

This requires complex surgery with a microscope and a high level of expertise to make it work.

Is finger replantation always successful?

In short, the answer is “No.” For many patients, replantation of fingers can be successful, and you can have a functioning finger back again, but not all. Somewhere between 50-80% of those surgeries are successful (meaning your finger is attached and alive too). Even in the best of cases, however, the finger is a “new normal.” That means that almost all reattached fingers have some degree of stiffness, numbness, pain, weakness, or some combination of those things.

Many structures need to be repaired in this operation, including the bone that was broken through, the tendons that flex and extend the finger, the nerves that give it sensation, and (most critically) the blood vessels that give the finger life. Those blood vessels are what make or break this operation. The other structures affect function later but are a moot point if the finger never lives. Those blood vessels require being sewn together with sutures that are smaller than a human hair.

Does everyone with an amputation get their finger reattached?

Again, the short answer is “No.” Unfortunately, some injuries have caused too much damage to various tissues in the finger to be able to be repaired, no matter how expert the surgeon.

It is essential to be evaluated by an expert hand surgeon, such as the board-certified surgeons at The Hand Center, who are experienced and comfortable with replantation surgery. This is essential because many factors are in play when deciding to try to reattach a finger. 

Patients’ underlying medical problems, age, smoking status (smokers have a lower success rate for sure), which finger it is, and at what level (the very tip versus the very base) all play a role in deciding to forge ahead with replantation of the finger. In my opinion, it is a very patient-specific decision, meaning that every single patient situation is different from every other and everyone should be evaluated individually.

My finger is reattached. What is next?

After successful surgery for finger replantation, patients are in the hospital for anywhere from several days to more than a week. The goals after surgery are very specific: medicines to help the blood keep flowing to the newly attached finger as well as restrictions with movements and diet to help the finger stay alive. Patients are often in an ICU setting right after surgery so the finger can be watched very closely. Sometimes, patients' fingers start dying again after surgery and require urgent repeat surgery to fix whatever problem is occurring

My finger has survived, and I leave the hospital; now what?

Therapy, therapy, therapy. Fingers love to get stiff after even small injuries, let alone having been amputated from the body. The bone needs to heal. The tendons get sticky. The nerves take a while to recover and give sensation back. All of the facets of recovery from a finger replantation surgery require expert hand specific therapists to work with patients diligently for maximizing finger function. At The Hand Center, we have an expert staff of therapists that work hand-in-hand with the physicians, physician assistants, and the patients so everyone is together through the recovery journey.

Closing thoughts

Finger replantation surgery is the most challenging surgery that hand surgeons can perform, and not all hand surgeons perform those surgeries. At the same time, this can be the most rewarding surgery we perform. I love this operation and love the opportunity to evaluate patients who unfortunately have had an amputation to finger(s) so together we can make the appropriate decision for their life. 

At The Hand Center, we have the experience and the desire to take care of these complex injuries. We have four convenient locations in Hartford, Glastonbury, Tolland, and Bloomfield, Connecticut. 

For expert consultation on finger replantation and comprehensive care for conditions and ailments affecting their hands, wrists, elbows, and shoulder, contact us to schedule an appointment.

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