The treatment of an amputation starts immediately after amputation. That is placing the amputated part in cold ice slush and transporting it to a replantation facility like ROC. Upon arriving in an emergency facility, the patient is prepared for surgery while the amputated part is taken to the operating room, cleaned and dissected out under a microscope, preparing it for replantation. Replantation can be successful with amputations beginning at the most distal joint (DIP joint) and more proximal amputations towards the shoulder. That is because the arteries and veins become too small to repair if it is beyond the DIP joint. However, in selected cases, after discussing the case with the patient (parents), your surgeon at ROC may decide to attempt replantation of a tip with a variant of the technique. This is especially true and important for fingertip amputations in the pediatric population where the tip can be sutured back as a composite graft. Your surgeons at ROC have long experience with many cases of children that have had their amputated fingertips successfully reattached. During a replantation, the bone is fixed first, followed by the repair of the tendons, then the nerve, then whether you fix the arteries or veins first is surgeons choice since some prefer to fix the vein first to prevent excessive bleeding from the veins and others prefer fixing the arteries first to more easily visualize the veins. The skin is then carefully closed and it may require the use of skin grafts to avoid tension on the closure. The extremity is then placed in a long arm well padded splint to protect the replanted part. Regularly the patient is admitted to the hospital for approximately 5 days and is kept in a warm, calm, controlled environment with blood thinners to keep the vessels flow going.
Replantations need of a comprehensive, well structured hand therapy program to start motion as early as possible and prevent complications from stiffness and adhesions on the replanted part or adjacent non-injured digits. This is a challenging task for the therapist because they have to find the right balance between motion, effort and protection of all repaired structures (fracture fixation, skin grafts, tendon, nerve and vessel repairs). The obvious consequences of inappropriate therapy are failure to achieve best possible function, rupture of repairs or in the worst case scenario, loss of replanted parts. This is why you must attend to a qualified and experienced Hand Therapy Facility like ROC- Therapy to complement the efforts of a replant surgery.
Amputations that are from the forearm to the shoulder are more successful if it occurs in patients younger than 15 years of age, is a clean cut and the part is brought for amputation immediately. Partial amputations with skin still attached should be left attached since valuable blood supply may still be supplied through the retained tissue. If an amputation is an avulsion which is a pulling injury, or a severe crush injury, has severe contamination, extensive tissue damage, double level of injury, the likelihood of a successful replantation is significantly less. Other important factors like time from injury, level of amputation, heart disease, diabetes, renal disease, hypertension, peripheral vascular disease, advanced age and smoking habit amongst others, will affect the prognosis and final decision to attempt a replantation. Regardless of the type of amputation, bring in the amputated part immediately for the surgeon to assess the replantation likelihood of success.