Replantation, digit, excluding thumb (includes distal tip to sublimis tendon insertion), complete amputation
CPT4 code
Name of the Procedure:
Replantation, digit (excluding thumb). Also referred to as digital replantation or digit reattachment surgery.
Summary
Digital replantation is a surgical procedure to reattach a completely amputated finger (not including the thumb) back to the hand. It involves meticulously reconnecting bones, tendons, nerves, and blood vessels to restore function and appearance as much as possible.
Purpose
The procedure addresses complete amputation of a digit and aims to restore function, sensation, and appearance. The primary goals are to reestablish blood flow, provide structural stability, and regain some degree of motor function and sensation.
Indications
- Complete amputation of a finger at any level up to the insertion of the flexor sublimis tendon.
- Patients with healthy tissue at the amputation site.
- Patients who are in good overall health and can tolerate lengthy surgeries.
- Absence of severe contamination or crush injury to the amputated digit.
Preparation
- Patients may need to be fasting for several hours before the procedure.
- Medications, particularly blood thinners, may need to be adjusted under a doctor's guidance.
- Preoperative tests such as blood work, imaging studies, and possibly an EKG are conducted to assess overall health.
- Consultation with a surgeon to understand the procedure, risks, benefits, and obtain written consent.
Procedure Description
- Anesthesia: The patient is given general anesthesia to ensure they are fully asleep and pain-free during the surgery.
- Debridement: Both the amputated part and the residual finger stump are cleaned and prepared surgically.
- Bone Fixation: Bones are stabilized using wires or mini plates and screws.
- Tendon Repair: Flexor and extensor tendons are meticulously repaired to allow movement.
- Nerve Repair: Nerves are aligned and sutured to restore sensation.
- Vascular Repair: Arteries and veins are reconnected under a microscope to reestablish blood supply.
- Closure: Skin is sutured and the digit is bandaged.
Duration
The procedure generally takes between 4 to 12 hours, depending on the complexity of the injury and the method used for reattachment.
Setting
Typically performed in a hospital operating room equipped for complex microsurgery.
Personnel
- A lead surgeon specializing in plastic or hand surgery.
- Surgical assistants or residents.
- An anesthesiologist.
- Operating room nurses and scrub technicians.
- Microvascular specialists, if available.
Risks and Complications
- Infection at the surgical site.
- Blood vessel thrombosis leading to failure of replantation.
- Nerve damage that may lead to loss of sensation.
- Stiffness or loss of movement in the reattached finger.
- Need for additional surgeries.
- Psychological impact of dealing with functional limitations and surgical outcomes.
Benefits
- Potential to regain functional use of the finger.
- Improved cosmetic appearance of the hand.
- Possibly better quality of life compared to prosthetic alternatives.
- Enhanced sensation and movement over time with successful replantation.
Recovery
- Hospital stay of several days to monitor blood flow to the reattached digit.
- Pain management with medications.
- Immobilization of the hand for a few weeks.
- Physical therapy to regain strength and mobility.
- Follow-up appointments to monitor healing and progress.
- Recovery can take several months, and full function may take longer to achieve.
Alternatives
- Prosthetic options: Artificial fingers can be custom-made for aesthetic purposes and some degree of function.
- Revision amputation: Surgical closure of the amputation site without reattachment.
- Bone shortening and tendon transfer: To improve remaining hand functionality.
- Pros: Less complex surgery, shorter recovery time.
- Cons: Loss of natural digit functionality and sensation.
Patient Experience
During the procedure, the patient will be under general anesthesia and will not feel anything. Post-procedure, there will be significant pain and discomfort, which can be managed with medications. Swelling, bruising, and a temporary loss of function are expected. The patient will be given comprehensive care instructions, including how to keep the area clean, signs of complications to watch for, and when to seek further medical advice. Regular follow-ups and a strong commitment to rehabilitation are crucial for optimal recovery.