20827 Replantation, thumb (includes distal tip to MP joint), complete amputation

Name of the Procedure:

Replantation, thumb (includes distal tip to MP joint), complete amputation

Summary

Replantation of the thumb is a surgical procedure to reattach a thumb that has been completely severed. This meticulous surgery involves reconnecting the blood vessels, nerves, muscles, and bones to restore form and function to the thumb.

Purpose

This procedure addresses the complete amputation of the thumb. The goal is to restore both the appearance and the function of the thumb, allowing for a higher degree of hand utility and normalcy in daily activities.

Indications

• Complete amputation of the thumb from the distal tip to the MP (metacarpophalangeal) joint.
• Patient is in good overall health to withstand surgery and recovery.
• The thumb is viable for reattachment and has been properly preserved since amputation.
• The patient can participate in post-surgical rehabilitation.

Preparation

• Patients will be instructed to fast for a specified period before the procedure, usually 8-12 hours.
• Any regular medications may need adjustments; particularly blood thinners.
• Diagnostic tests like blood work, imaging studies, and assessments to gauge overall health and suitability for surgery will be conducted.
• The amputated thumb should be preserved in a clean, moist cloth and kept cool (but not frozen).

Procedure Description

1. Anesthesia: General or regional anesthesia is administered to ensure the patient is pain-free.
2. Debridement: The severed ends of the thumb and the hand are cleaned and any non-viable tissue is removed.
3. Bone Fixation: The bones are rejoined and fixed with plates, screws, or wires.
4. Tendon Repair: Tendons are meticulously sutured together.
5. Vascular Repair: Arteries and veins are reconnected under a microscope using microvascular techniques to ensure blood flow.
6. Nerve Repair: Nerves are repaired to restore sensation and motor function.
7. Skin Closure: The skin is carefully sutured, ensuring minimal scarring and optimal healing.

Duration

The procedure typically takes 6-12 hours, depending on the complexity of the injury and the response during surgery.

Setting

Replantation is performed in a hospital setting, often in a specialized surgical center equipped for microsurgery.

Personnel

• A team led by an orthopedic or plastic surgeon specialized in hand surgery.
• Anesthesiologists for administering and monitoring anesthesia.
• Surgical nurses and assistants for intraoperative support.
• Postoperative care team including nurses and physical/occupational therapists.

Risks and Complications

• Infection
• Poor wound healing or necrosis
• Nerve damage resulting in loss of sensation or function
• Blood vessel issues leading to inadequate blood supply and potential for re-amputation
• Stiffness or reduced mobility
• Pain or hypersensitivity at the reattachment site

Benefits

• Restoration of thumb appearance and various degrees of function.
• Enhanced ability to perform daily tasks requiring gripping and grasping.
• Psychological benefit from maintaining body integrity. Benefits are often realized gradually over months through continuous rehabilitation.

Recovery

• Initially, the patient will stay in the hospital for monitoring, often a few days.
• Pain management with prescribed medications.
• The thumb will be immobilized initially to facilitate healing.
• Thorough follow-up appointments to monitor the replantation success.
• A long-term physical and occupational therapy plan to regain function and strength, typically up to 6-12 months.
• Restrictions on heavy use of the hand until approved by the healthcare provider.

Alternatives

• Prosthetic Thumb: Use of a prosthetic thumb can provide some degree of functionality but lacks the sensory feedback of a natural thumb.
• Thumb Reconstruction: In cases where replantation isn't possible, reconstructive surgery using other body parts may be considered.
• Metacarpal Lengthening: Lengthening the existing metacarpal bone to improve hand function without a thumb.

Pros of replantation include the potential for full sensory and motor function, while cons involve higher risk and more extended recovery compared to prosthetics.

Patient Experience

• During Procedure: Under anesthesia, the patient will not feel pain during surgery.
• After Procedure: Post-surgery, the patient may experience pain, swelling, and numbness initially.
• Pain Management: Pain will be managed with medications and localized therapy.
• Rehabilitation: Active participation in rehabilitation exercises is crucial for optimal recovery and regaining function.
• Long-term: Patients can expect gradual improvements over several months, and it is essential to maintain follow-up appointments for the best outcome.