Emergency reattachment of amputated fingers and hands.
Replantation is emergency surgery to reattach a finger, hand or limb that has been completely cut off. Vessels, nerves, tendons and bone are repaired under a microscope. Success depends heavily on how quickly the part reaches a microsurgical unit, so this is measured in hours, not days.
Control the bleeding first. Firm, steady pressure with a clean cloth works better than a tourniquet in most cases. Raise the injured hand above the level of the heart.
Then look after the amputated part, because it is often handled wrongly. Wrap it in clean, slightly moist gauze. Seal that inside a plastic bag. Place the sealed bag on ice. Never put the part directly on ice, and never place it in water. Direct ice contact freezes the tissue and water waterlogs it, and either can make an otherwise repairable part unsalvageable.
Call ahead so the theatre and team can be prepared before you arrive. Every minute saved improves the chance of success.
Clean, sharp cuts do best because the vessels and nerves have a defined edge that can be joined accurately. Crush injuries and avulsion injuries, where the part is torn away, damage the vessels along a long stretch and are far more difficult.
Thumbs are almost always attempted, because the thumb accounts for a large share of hand function. Multiple fingers, hands and children's injuries are also strongly considered. A single finger amputation in an adult, particularly at a certain level, is sometimes better managed by shortening and closing, since a stiff replanted finger can work worse than none at all. That judgement is made honestly, in your interest, not for the sake of attempting a difficult operation.
Bone is shortened slightly and fixed first, which allows the vessels and nerves to be joined without tension. Tendons are then repaired, followed by arteries and veins under the microscope, then nerves, then skin.
Joining vessels roughly a millimetre across requires stitches finer than a human hair. Restoring both arterial inflow and venous outflow matters equally, because a part that receives blood but cannot drain it will still fail. This is why the operation takes many hours even for a single digit.
The first three to five days are the critical period. The replanted part is checked constantly for colour, warmth and refill. If circulation fails, returning quickly to theatre can sometimes save it, which is why the stay is in hospital rather than at home.
Rehabilitation then begins and continues for months. Movement returns before sensation, because nerves regrow slowly. Cold intolerance is common for a year or more and usually improves. Complete return to the pre-injury state is rare, and the honest goal is a hand that works, not a hand that looks untouched.
| Factor | What it covers |
|---|---|
| Fingers | Cooled correctly, several hours are usually available |
| Hand or forearm | Muscle is far less tolerant, so the window is much shorter |
| Warm, uncooled part | The window shortens sharply, so cooling is critical |
| Crush or avulsion | Lower success even when time is short, because vessels are damaged widely |
These pages answer the questions that most often come up alongside this one.
As fast as possible. For fingers, cooled correctly, there are usually several hours. For a hand or forearm the window is much shorter, because muscle tolerates loss of blood supply poorly. Cooling the part properly extends the time available, so it is worth doing even in a rush.
Wrap it in clean, slightly moist gauze, seal it inside a plastic bag, and place that bag on ice. Direct contact with ice causes freezing injury and water causes waterlogging, and either can make the part impossible to reattach.
Rarely exactly as before. Most successful replantations regain useful grip and protective sensation, but some stiffness and cold intolerance usually remain. Function is the goal, and it depends heavily on the type of injury and on rehabilitation.
No, and that is important to say. A single finger amputation at certain levels in an adult can heal faster and work better if the stump is shortened and closed, rather than replanted and left stiff. The decision is made case by case in your interest.
Usually five to seven days for a finger, and longer for a hand or limb. The stay covers the critical period when circulation is monitored closely and problems can still be corrected in theatre.
It varies widely with the type of injury. Clean cuts that reach a microsurgical unit quickly do considerably better than crush or avulsion injuries. An honest figure can only be given after the injury is examined, so beware of a percentage quoted over the phone.
Splinting, then guided movement, then strengthening, over several months. Sensation returns slowly as nerves regrow. Skipping rehabilitation is the commonest reason a technically successful replantation ends up with a stiff, unhelpful finger.
Emergency replantation after trauma is frequently covered, and the hospital team assists with documentation and pre-authorisation. Treatment is never delayed while cover is being confirmed, because the surgery is time critical.
Published with written patient consent and shown for education rather than promotion. Every case is different and these images are not a promise of results.
Consultations at Kiran Hospital, Katargam, Surat. Outstation and NRI patients can request a video consultation before travelling.