The goal of replantation (commonly known as re-implantation or re-attachment surgery) after traumatic amputation is successful restoration of function. Simply returning circulation to an amputated part does not in itself define success. The aim of both the patient and the surgeon is useful function and restoration of sensation – replantation of a part that will not perform useful activity should be avoided.
With the advancement in microsurgical techniques replantation has become more common, and can be performed with great success both aesthetically and functionally. Replantation of amputated parts has been performed in amputated fingers, hands, forearms, feet, amputated ears, avulsed scalp injuries, an amputated face, amputated lips, amputated penis and even in an amputated tongue. These injuries can arise from multiple potential etiologies including trauma (often industrial), machine injuries, assault or even self-mutilation. We will focus on finger and upper extremity replantation here since they are much more common than other amputations.
Decision making in replantation must take multiple factors into consideration. Wether to proceed requires an assessment of the patient, including history, physical examination and medical co-morbidities and occupation. An examination of the amputated part(s) and of course the affected limb is required to understand the extent of injury and potential for success and useful functional outcome. The feasibility of replantation may not be certain on gross inspection and may not be apparent until after surgical dissection intraoperatively.
A radiographic evaluation is invaluable for the assessment of the extent of bone injury and or loss.