Advances in the field of microsurgery have made it possible the reattachment or replantation of hands, fingers or limbs. Special sutures and microscopes for surgery have tremendously helped microvascular surgeons to achieve the almost impossible task of reattaching or replanting organic member of the human body.
Remarkable advances in microsurgery have made it possible to reattach amputated limbs. Special microsutures and microscopes for surgery have been developed which allow a microvascular surgeon to repair the blood supply to the reattached limb. Microvascular surgeons have developed new techniques for repairing these very small blood vessels. These surgeons, originally trained in orthopaedic, plastic and general surgery, receive additional training in this highly specialized area.
Recovery and reattachment
The sudden loss of a finger or hand can be a devastating injury. But with emergency surgery by trained microvascular surgeons, dramatic recovery of the use of one’s hand is possible. Reattachment of amputated fingers or hands requires emergency surgery  under a microscope. This surgery is complicated and the recovery time is long. Patients should discuss the specifics of the surgery with their physicians. The reattachment can only be done under a microscope designed for surgery, where microvascular operations can be had.

Before surgery
Pre-surgical factors
Several pre-surgical factors may increase or decrease the possibility for successful replantation surgery.
The severity of the injury can affect what parts of the hand or fingers are able to be saved.
Cooling the amputated part can substantially increase the time that can elapse between injury and surgery. When preparing patients for transfer to a replantation center, emergency medical personnel will package the amputated limb or digits on ice in order to optimize the chance for successful replantation.
A key factor in improving the success for patients with finger and hand amputations is the emergency hospital network. This includes rapid transportation by ambulance or air. Emergency technicians arrange for transportation and insure that bandages, X-rays, antibiotics, intravenous fluids and tetanus shots are provided rapidly.
Details of the surgery
Length of surgery
Surgery may last between 4 and 24 hours. Longer operations are necessary when multiple individual digits have been amputated. The surgery is frequently done with several operating teams. This decreases the overall surgery time needed.
About the surgery
Before surgery the patient’s injuries are cleaned very carefully to avoid deep infection. Any fractured bones are stabilized first, using small pins or metal plates. Next the tendons are repaired.
Repair of the delicate nerves, arteries and veins is done in the last stage of the procedure. These repairs are performed under operating microscopes, using microsurgical techniques.
In severe injuries, vein or skin grafts are taken from another site, such as the forearm, foot or thigh. Vein grafts help to replace missing segments of arteries or veins. Skin grafts are necessary when the injury or swelling prevents the skin edges from closing.
After surgery
Post-surgical care
Patients are watched closely for the first 48 hours. The patient’s room is kept very warm after surgery to keep blood vessels dilated and to prevent blood clot formation.
Blood thinning medication is required for up to a week after surgery. This medication prevents clot formation, a major cause of replantation failure.
Smoking and drinking caffeinated beverages is restricted for three weeks from the time of surgery. Smoking and caffeine can increase chances of clot formation in the repaired vessels leading to failure of the replant.
The hand or arm is wrapped in a bulky bandage for protection and to decrease swelling. Before leaving the hospital, these bulky dressings are often changed to a smaller bandage and splint.
Therapy to restore motion is started before leaving the hospital.
Check with your doctor about your overall recovery time.
Risks
Blood clot formation can prevent blood flow to the reattached limb. To reduce the risk of blood clots, special blood thinning medications are given.
Because multiple tendons and bones are frequently injured some loss of motion (stiffness) occurs after all replantations. More severe crushing types of injuries result in a greater degree of stiffness. Original article