Reimplantation of
Cut Body Parts
Microvascular Surgery
Restoring life to a dead part has always been a dream of every surgeon.
Restoring life to a dead part has always been a dream of every surgeon. Replantation restores life to the lifeless extremity: a miracle of modern surgery. When a body part is completely cut off from the body, it still has alive tissues for few hours after that. Therefore, it is possible to re-attach the body part back to its original place with full function if it is brought to a place where Microvascular surgeon is available within time. This re-attachment is known as Reimplantation surgery. Replantation needs quick action after the accident from both patient and surgical team side.
This is a long time taking and skillful procedure in which all the small blood vessels and nerves supplying the cut body part are sewed again together under very high magnification through a microscope by a skilled plastic surgeon along with re-attachment of muscles, tendons, bone and ligaments.
Which parts can be replanted?
Reimplantation of amputated parts can be done for amputated fingers, hands, forearms, arms, toes, feet, legs, ears, scalp and penis.
Transportation of body part
Most critical factor in replantation surgery is transportation of amputated part. To increase the chances of successful reimplantation, the amputated body part should be immediately kept in clean and cool (but not freezing) container wrapped in a moist cotton linen.
- Part is wrapped in moist saline gauze and placed in a waterproof plastic bag
- Plastic bag is placed in a ice container
- Part should not come into direct contact with the ice
Part should not be freezed as freezing can cause direct irreversible damage to microvascular system.
Timing of reimplantation
Timely efficient transportation of the patient and amputated part to the hospital is critical for survival and function. Muscle undergoes irreversible damage with ischemia in time greater than 6-9 hours.
Small parts like the fingers, can reimplanted up to as long as 90 hours, although clinical practitioners consider 6 hours as a standard time for successful result of the surgery for any body part. Because after that, there is permanent damage to the tissues which cannot be resolved even after successful restoration of blood flow in the body part.
Sometimes the body parts which cannot be reimplanted should also be collected so that it can be useful in taking skin, nerve or tendon or vein graft for salvageable limb.
Management at Hospital Emergency
Patient presented with amputated part is attended at urgent basis. Patient's vitals are checked and patient is examined for any other injury.
Amputated part is examined and preserved.
OT is arranged at the earliest and investigations are sent
Patient with amputated part sent to OT for replantation surgery
Procedure of Reimplantation
The repair of nerves and vessels (artery and vein) of the amputated part is essential for survival and function of reimplanted part of body. Using an operating microscope for reimplantation is termed microvascular reimplantation.
In reimplantation surgery following macro-amputation (e.g. arm or leg amputation) maximal length of the reimplanted extremity is preserved by using vein grafts for blood supply and pedicled or free flaps for defect coverage.
Two surgical teams' approach is followed. Both amputated part and the patient undergo simultaneous surgery.
Amputated part
- Using microscope magnification all structures are examined
- Neurovascular structures are identified and examined
Patient
- Under anesthesia, the proximal level of amputation is examined
- Catheterization is done, hydration is maintained and Proper body warming ensured
Repair
- Bone fixation
- Arterial repair
- Venous repair
- Nerve repair
- Muscle, tendon repair
- Skin
Post operative care
Patient is under rigorous monitoring in post operative period in first 5-7 days
Limb/Part immobilization is done using plaster slab
Reimplantation is one of the major surgeries causing a lot of stress on the patient's body environment therefore these patients require continuous monitoring for at least 48 hours. Also, the reimplanted part has to be assessed every 2 hourly for its viability. For this color, turgor and temperature of the part is assessed and also the blood flow.
Anticoagulation protocol is followed for sustaining blood flow to the cut part after the surgery.
Monitoring every 2nd hourly for first 2 days
- Assessing color of finger (pink is good)
- Assessing temperature of finger (comparable to body temperature)
- Turgosity of the part
- Dermal bleeding (bright red color is good)
If clinical observation is doubtful, Doppler ultrasound is done to confirm the flow and in case there is absent or decreased blood flow, patient is immediately taken for surgery again. To avoid this situation, proper hydration with fluids, antibiotics, blood thinning drugs are given.
Blood vessels and nerves are protected for 3-4 weeks
Few blood thinning medications are given every day for up to 6 weeks following reimplantation.
Following the recovery, physiotherapy is done to achieve complete movements. Patients can successfully use the limb and finger again after completed surgery which could take months.
Many times, complete recovery is not possible in single stage surgery and staged reconstructive surgery is required in future to achieve better movement of the limb.
Shaping dreams through
Know your surgeon better
Best plastic surgeon, Dr. Amit Agarwal is an American Board Certified, extensively trained, and best Plastic & Aesthetic surgeon in Lucknow. He is the Chief Plastic Surgeon heading the Department of Plastic, Microvascular, and Craniofacial surgery at Vivekananda Polyclinic and Institute of Medical Sciences, Lucknow, U.P, India. He maintains a busy practice at Avadh and Nishat Hospital and his own center - Kayakriti Plastic Surgery & Dental Center. He was formerly a Consultant in the Department of Plastic Surgery and Burns at the prestigious SGPGI, Lucknow.
MS, DNB (General Surgery) MCh, DNB (Plastic Surgery),
MNAMS, FACS, FICS, FRCS (Edinburgh, UK)
His Credentials
Three pillars of kayakriti
Privacy
We believe your experience with us should be comfortable and hassle-free to make it one of your best lifetime experiences for yours. We, here at the clinic, take full precautions to maintain your privacy in any manner. We also provide a staff who will receive you from the gate and take you to the chamber directly if you demand.
Trust
Our Surgeon is highly qualified and internationally certified with a team of skilled staff to perform any surgical or non-surgical treatment on your body.
Safety
When you plan to undergo any surgery you should always keep in mind that it's your body and it's a surgery. We, here always keep your safety a priority and will never recommend you to undergo any such procedure which is not safe for you. We also provide you with a detailed description of the complications which may occur after the surgery during the consultation as it's a surgical procedure so there may be some complications depending on the way your body reacts.
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Frequently Asked Questions
If you have flat or small breast and you want to improve your breast and hip contour ratio then you are a good candidate for it. The answer will be best provided after the first consultation with Dr Amit Agarwal.
Acute pain will be there for almost a week which gradually reduces and there will be soreness and swelling which may take up to 3 weeks to subside.
You can join your work and daily routines after a week of the procedure and can start exercising after 3 weeks of it.
Yes, you have to wear it round the clock unless we suggest you to remove it.
This surgery does not affect the ducts or the areas of the breast involved in milk production. Thus, it does not affect the breast feeding.
This surgery does not affect the ducts or the areas of the breast involved in milk production. Thus, it does not affect the breast feeding.
Kayakriti Plastic Surgery & Dental Center
D-43, Near Punjab National Bank, Rajajipuram, Lucknow, Uttar Pradesh - 226017, India
Phone No. +919695940009, +919695940006
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