Last updated: 11/24/2009

To increase efficiency, the replantation team splits into two sub-teams. One sub-team in the operating room cleans the amputated finger with sterile solutions, places it on ice, and identifies and tags (with special surgical clips) nerves and...

blood vessels. Dead or damaged tissue is surgically removed with a procedure called debridement. The emergency room (ER) sub-team will assess the patient during a physical exam with x rays of the injured area, blood analysis, and cardiac (heart) monitoring. The patient is given fluids intravenously (IV), a tetanus injection, and antibiotics. Usually, most finger reattachments are performed with a local anesthetic such as bupivacaine and a nerve block to numb the affected arm. Maintaining a warm body temperature can enhance blood flow to the affected limb.

The surgical procedure consists of several stages. The bone in the amputated finger must be shortened and fixed, which means that the bone end is trimmed. After this process, the bone is stabilized with special sutures called K-wires, and fixed pins are placed in the bone after drilling a space to insert them. This process connects the two amputated bone fragments. After bone stabilization and fixation, the extensor and flexor tendons are repaired. This step is vital, since arteries, veins, and nerves should never be surgically connected under tension. Next, the surgeon must repair (suture) cut-off tendons, arteries, veins, and nerves. Healthy arteries and veins are sutured together without tension. A vein graft is used for blood vessels that cannot be reattached.

Nerve repair for finger reattachment is not difficult. Since the reattached bone parts are shorter than the original length, nerves can be reattached without tension. A microscope is used for magnified visualization of finger nerves during reattachment. When the severed ends of the nerve cannot be reattached, a primary nerve graft is performed. Finally, it is vital superficial veins on the affected finger (dorsal veins) to cover with a skin flap to prevent death of the venous vessels. The skin over the surgical field is loosely sutured with a few sutures. Any damaged tissue that may die (necrotic tissue) is removed. No tension should be placed on the skin fields during closure of the wound. Wounds are covered with small strips of gauze impregnated with petrolatum. The upper extremity is immobilized, and compression hand dressing and plaster splints are arranged to prevent slipping and movement of the affected arm.