Revascularization and replantation of digits and hand

Indications

• The aim of digit replantation is not only to restore vascularity but also regain useful function. There are many factors that influence the final decision, including the type of injury; level of amputation; which digit was injured; and patient factors, such as age, personal expectations, and professional needs. The surgeon should weigh functional achievements against treatment costs when considering revision amputation versus replantation. Discuss all considerations with patients thoroughly before a final decision is made.

• Absolute indications include thumb amputation ( Fig. 94.1 ), multiple digit amputations ( Fig. 94.2 ), and any amputation in a child.

  
  

• Relative indications include single finger amputation distal to the flexor digitorum superficialis (FDS) insertion and ring finger avulsion amputation.

Clinical examination

• A thorough history collection and an appropriate trauma evaluation are made first to exclude conditions that are not suitable for replantation.

• Both the amputated part and proximal part are carefully checked. Mechanism of injury, ischemic time, and preserving method are obtained before surgery.

• The patient’s overall health and comorbid conditions should be carefully evaluated, which will contribute to making the final decision.

Imaging

Plain radiographs, typically consisting of posteroanterior (PA) and lateral views, should be taken to evaluate the extent of the bone injury of both the injured hand and the amputated part ( Fig. 94.3A–C ).