Replantation

Replantation or reattachment has been defined by the American Society for Surgery of the Hand as 'the surgical reattachment of a body part, most commonly a finger, hand or arm, that has been completely cut from a person's body.' Replantation or reattachment has been defined by the American Society for Surgery of the Hand as 'the surgical reattachment of a body part, most commonly a finger, hand or arm, that has been completely cut from a person's body.' According to the ICD-10-PCS, in the Medical and Surgical Section 0, root operation M, reattachment is the putting back in or on all or a portion of a separated body part to its normal location, or other suitable location. Vascular circulation and nervous pathways may or may not be reestablished. Examples would be reattachment of a partially or fully amputated hand, or reattachment of a kidney that had suffered an avulsion-type injury. Replantation of amputated parts has been performed on fingers, hands, forearms, arms, toes, feet, legs, ears, avulsed scalp injuries, a face, lips, penis and a tongue. It can be performed on almost any body part of children. Replantation is performed in response to traumatic amputation. Sharp, guillotine-like injuries with relatively uninjured distal extremities have the best post-replantation prognosis. Severe crush injuries, multilevel injuries, avulsion injuries, and in some cases jagged tearing of tissue, can preclude replantation and salvage, requiring revision amputation of the stump. Replantation requires microsurgery and must be performed within several hours of the part's amputation, at a center with specialized equipment, surgeons and supporting staff. To improve the chances of a successful replantation, it is necessary to preserve the amputate as soon as possible in a cool (close to freezing, but not at or below freezing) and sterile or clean environment. Parts should be wrapped with moistened gauze and placed inside a clean or sterile bag floating in ice water. Dry ice should not be used as it can result in freezing of the tissue. There are so called sterile 'Amputate-Bags' available which help to perform a dry, cool and sterile preservation. Parts without major muscles such as fingers can be preserved for as long as 94 hours (typically 10–12 hours), while major muscle containing parts such as arms need to be re-attached and revascularized within 6–8 hours to have a viable limb.