Replantation of digits

Description:
While the patient is sleepy (sedated) or deep asleep and pain-free (regional anesthesia or general anesthesia),the bone ends are shortened to eliminate tension on the repaired vessels. The bone is stabilized with wires. Tendon repairs are done next. Digital nerves and vessels are repaired with microsurgical instruments. This part of the surgery is most critical to its success. The skin is then closed. A bulky dressing is applied. Young children may have a cast applied to protect the area from injury.

Indications:
The surgery is recommended in a case of amputated fingers or toes, with salvaged digits in a condition that would enable replantation.

What to Expect After:
Children are especially good candidates for replantation surgery because of their great ability to heal and regenerate tissue. Replantation of an amputated part is ideally performed within 4 to 6 hours after injury, but success has been reported up to 24 hours after the injury if the amputated part has been cooled. Proper care of the amputated part(s) is vital to successful replantation. Under proper conditions, the long-term prognosis for the restoration of function in the digit is quite good.

Convalescence:
Special care is needed in the hospital to monitor and maintain the circulation to the replanted part. The extremity will be kept elevated. The room may be kept quite warm to ensure that the circulation to the skin is not altered due to cooling. After discharge from the hospital in about a week, your child may wear a cast to protect the part. Continuing circulation checks are necessary.

Risks:
Risks for any anesthesia are:

Risks for any surgery are:

Additional risks include:

  • death of the replanted tissue
  • reduced nerve or motor function in the replanted digit



Cost:
The costs of any surgery varies significantly between surgeons, medical facilities, and regions of the country. Patients who are younger, sicker, or need more extensive surgery will require more intensive and expensive treatment.

Surgery charges can be separated into five parts: 1) the surgeon's fee, 2) the anesthesiologist's fee, 3) the hospital charges, which includes nursing care and the operating room, 4) the medications, and 5) additional charges.

1. Surgeon's fee: approximately $2,000
2. Anesthesiologist's fee: averages $350 to $400 per hour
3. Hospital charges: basic rate averages $1,500 to $1,800 per day (more for the intensive care unit (ICU) or private rooms)
4. Medication charges:
5. Additional charges: assisting surgeon, treatment of complications, diagnostic procedures (such as blood or X-ray exams), medical supplies, or equipment use.

Insurance coverage for surgery expenses depends on many factors and should be explored for each individual instance.


The thumb of this person was amputated in an accident. In this sequence of pictures, it is reattached. The final picture is the appearance of the thumb after it is almost healed.