Replantation surgery
Fingers can be kept alive by grafting them on an arm
Prior to replantation surgery
It is really only possible to attempt to reconnect an amputated body part if the cut is relatively clean, in relatively good condition and contains blood vessels that can be reattached to establish a flow of blood through the tissue.
It is also important to remember that some damage, for instance bite or crush marks, may only become apparent once the tissue has been reconnected, and blood flow is re-established.
The amputated body part should be kept cool. Ideally, it should be wrapped in a moist cloth, and put into a plastic container surrounded by ice.
The best temperature for the tissue is 4C. Any lower and there is a risk of tissue damage, or cold burn, caused by the crystallisation of water within the cells of the tissue.
Reducing the temperature of the tissue helps to slow down its metabolic rate, so that the cells can go without their usual supply of nutrient and oxygen while detached from the blood supply.
The surgical procedure
The amputation site must be clean to attempt replantation
Wherever possible, surgeons will attempt to reconnect the amputated body part to the original site of amputation.
This is only possible if the tissues at the site of amputation are not too damaged, and will generally take place under general anaesthetic.
The first task is to reattach the amputated body part to the bone. It may be necessary to shorten the bone at the site of amputation, or to use steel wire, or metal plates to fix the part in place.
The surgeons must then establish a blood flow by reconnecting the blood vessels in the amputated body part to those at the site of amputation.
Nerves and tendons will then be reconstructed. Tendon reconstruction may involve the use of skin grafts, or more complex repair work using flaps of tissue that have their own blood supply.
After surgery
Once surgery has been completed, it is vital that the patient is closely monitored to ensure the blood supply has been successfully re-established.
Doctors monitor the colour and temperature of the reconnected tissue, the patient’s core temperature, and that of the body’s extremities.
Measuring the amount of urine the patient produces is an accurate way to assess whether they have a sufficient volume of blood.
If necessary the patient is given fluid, or even a blood transfusion.
Grafting tissue elsewhere on the body
Where the site of amputation is badly damaged, as was the case in the Samurai sword attack, it is not always possible to reconnect an amputated body part immediately.
In this instance, surgeons have developed a technique for “banking” the tissue elsewhere on the body until the site of amputation can be repaired.
Repair work may include nerve and tendon grafts, and the removal of damaged tissue. Limbs may be shortened to reveal healthy tissue suitable to accept the replanted body part.
“Banking” involves attaching the blood vessels of the amputated body part to healthy blood vessels surgically exposed at another site – in the case of the Samurai victim, the arm.
Surgeons do not usually attempt to reconnect bones, nerves or tendons at this stage.
Once attached, the body part is supplied with nutrients and oxygen until surgeons decide it is appropriate to attach it back to the original site of amputation.
This is a rare procedure and requires great skill. It has only been carried out successfully on limited occasions.
One of the most important aspects of the treatment is to prepare the patient psychologically to cope with the “banking”, procedure which can be seen as unsettling and bizarre.
The results
It is possible for amputated body parts to function well once they have been reattached.
The chances of success are increased if the patient is young, fit and healthy.
Replantation surgery has been particularly successful on the thumb.