Traumatic Amputations of the Upper Extremity/Replantation

Also known as: traumatic amputations of the upper limb, upper extremity replantation, re-implantation surgery, re-attachment surgery.

What are traumatic amputations of the upper extremity/replantation?

A traumatic amputation of the upper extremity refers to an injury in which part of the arm, hand or fingers are cut or torn from the body due to a traumatic accident. Replantation is a surgical procedure that is performed to reconnect amputated body parts.

What happens during the procedure?

The precise nature of the replantation procedure will vary based on the location and severity of the amputation. The procedure is usually performed under general anesthesia. The initial portion of the procedure involves careful and meticulous preparation of the amputated part and of the injured part of the body.

The procedure then involves repair of all of the structures of amputated part, including: bone fixation, tendon repair, nerve repair, artery repair, vein repair, and skin repair or graft. A microscope is necessary in the operating room, especially for repair of nerves and vessels in the hand and fingers.

Is any special preparation needed?

Replantation is a procedure that usually needs to be performed quickly. The patient should first be evaluated for any life-threatening injuries in an emergency room setting. IV access and baseline laboratory studies should be obtained. Tetanus immunization status should be checked, and tetanus toxoid should be administered if the patient’s immunization status is not up-to-date. The patient may not eat or drink anything in preparation for general anesthesia. X-rays should be performed of the affected extremity and of the amputated part.

The injured extremity should be dressed with dry sterile gauze and a bulky dressing. The extremity must be elevated above the level of the heart.

The amputated part should be wrapped in DRY gauze and then placed in a Zip-lock bag. The bag should then be placed on ice; do not wet the gauze and do not bury the bag beneath the ice.

In the case of a partial amputation, apply dry sterile gauze to the wound and elevate the extremity; a splint may be applied for comfort and protection.

What are the risk factors?

Infection, bleeding, and failure of the replanted part to survive or function properly are potential risk factors of replantation surgery for traumatic amputations of the upper extremity.

Reviewed by: Aaron Berger, MD

This page was last updated on: June 21, 2022 02:33 PM

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