Replantation and result

Replantation is the ultimate form of reconstruction following an amputation. It provides for like-for-like composite tissue and the best chance of functional recovery. The tissue loss and the replacement are actually the same as opposed to the transfer of a donor digit (eg: a toe) where the tissues may be similar but there are still differences; not only anatomical but also cultural and sociopsychological reasons. The donor morbidity in replantation surgery is minimal as compared to the transfer of the toe.

Functional recovery in terms of sensory recovery, active range of motion and cosmesis are important aspects of successful replantation after viability has been achieved by accurate microvascular anastomosis. In the long term, a good nerve and strong tendon repair with stable skeletal fixation without violation of the skin or joint will ensure a good outcome. Ischaemic time is also crucial and has to be kept in check.

Despite numerous reports of successful replantation following long ischaemic times, it is recognized that the longer the time to revascularization, the higher the chances of failure. The replantation team has to be well organized and efficient. The department provides a team whom are well versed in microvascular techniques and employ simple and yet effective methods of tendon repair and osteosynthesis. The department is committed to provide 24-hrs replantation service for limb amputation. Replantability is based on very good preservation technique. The most practical aspect of preservation is to keep the amputated digit cool and dry; not wet and frozen.

Replantation Surgery

Preserving the amputated digits or limbs

Tendon injuries

Tendon injuries in the upper limb are common and can be associated with damage to adjacent nerves and blood vessels. Mechanisms of injury include sharp lacerations, blunt trauma, avulsions, or ruptures due to attrition in the inflammatory conditions like rheumatoid arthritis.

All suspected tendon injuries should be explored in the operating theatre, using sterile technique and tourniquet control. Perioperative intravenous antibiotics and anti-tetanus prophylaxis should be routine. Delayed treatment will compromise the functional outcome.

Typical posture of a cut flexor tendon

Extensor tendon injury, pre and post operation

Where replantation is not possible or loss of limbs or digit could be salvage, we offer a range of complex microsurgical services including:

BIG TOE TRANSFER

Loss of digit

Big Toe Transfer

Doctors