The amputated part is carefully preserved in a damp gauze wrap inside a plastic bag placed on ice (not directly on ice). In theatre, the bone is shortened and fixed with K-wires or a plate. The extensor and flexor tendons are repaired. Using an operating microscope, the digital arteries and veins are repaired with microsurgical sutures finer than a human hair. The digital nerves are repaired. The skin is closed loosely. The operation takes four to twelve hours depending on the level and number of digits.
Replantation is strongly indicated for thumb amputations (the thumb provides 40% of hand function), multiple finger amputations, amputations in children (excellent outcomes), and mid-palm or wrist-level amputations. Single finger amputations in adults are more selectively replanted based on the level, mechanism, and patient factors.
Revision amputation (shortening and closing the stump) — this is a valid choice, particularly for single finger amputations in adults where replantation may result in a stiff, painful finger that impairs overall hand function. Prosthetic fingers are available for cosmesis.
Emergency. The amputated part must be preserved correctly — wrapped in moist gauze, placed in a sealed plastic bag, and kept on ice (not frozen). Ischaemia time is critical — ideally less than six hours for fingers (up to 12–24 hours if the part is cooled). The patient must be medically stable for a prolonged anaesthetic.
Successful replantation survival rates are approximately 80–90% at experienced centres. The replanted digit provides useful sensory and motor function, though it is never completely normal. Thumb replantation provides the greatest functional benefit.
StiffnessExpected
The replanted finger is always stiffer than normal. Total active motion is typically 50–60% of normal.
Cold intoleranceExpected
Hypersensitivity to cold is very common and may be permanent.
Reduced sensationExpected
Sensation returns but is never fully normal. Protective sensation is achieved in most cases.
Nail deformityCommon
The nail may be irregular.
Replant failureUncommon
The replanted digit may not survive despite technically successful surgery. Risk approximately 10–20%.
Vessel thrombosisUncommon
Blood clots in the repaired vessels, most commonly in the first 48–72 hours.
InfectionUncommon
Wound or bone infection.
Non-unionUncommon
The bone may fail to heal.
NeuromaCommon
Painful nerve scar tissue.
Secondary proceduresCommon
Tenolysis, nerve grafting, or revision surgery may be needed to optimise function.
General anaesthesia for prolonged surgery. Regional arm block may supplement. Warming, hydration, and vasodilators to optimise blood flow to the replanted part.
Hospital stay five to seven days with hourly vascular checks of the replanted digit. No smoking (vasospasm risk). Hand therapy begins at two to three weeks once wounds allow. K-wire removal at four to six weeks. Nerve recovery takes months (1 mm/day). Full rehabilitation six to twelve months. Secondary procedures may be needed.
Hourly vascular monitoring for 48–72 hours. Daily review for one week. Hand therapy from two to three weeks. Surgeon review at two weeks, six weeks, three months, and six months. Nerve recovery monitoring over twelve to eighteen months.
How is the amputated part preserved?
Wrap the part in moist saline-soaked gauze, place it in a sealed plastic bag, and place the bag on ice. Do NOT put the part directly on ice or in water. Do NOT freeze it. Bring it with the patient to hospital.
Is it always better to replant?
Not always. A stiff, painful, insensate replanted finger may impair overall hand function more than a well-healed amputation stump. The decision depends on which fingers are amputated, the mechanism of injury, the patient's age and occupation, and ischaemia time. Thumb replantation is almost always attempted.
How long does sensation take to return?
Nerves regenerate at approximately 1 mm per day. For a finger amputation, useful sensation typically returns over three to nine months, continuing to improve for up to two years.