Losing a limb or fingers can be devastating for a patient. Loss of function along with disfigurement can lead to deep psychological effects. Attaching a severed body part back captures human imagination like anything. We have references in mythology where amputated body parts were reattached by ancient Indian doctors. Today with advances in both Microsurgery (magnification of small structures) and ultrafine suture material (less than 70 microns) reattaching severed body parts is possible.
Mostly we get two types of limb loss one arising from sharp cutting machines or knives, the other from crushing machines or accidents. To reimplant sharp cut injuries are technically less difficult than crush injuries. The success rates for such injuries vary from 30%-90% depending upon the nature of injury and time since injury. Ideally, the patient should reach an equipped facility within 30-60 minutes of injury.
How to preserve the cut part?
Decision-making is also important both on the part of the surgeon and patient. Weather reimplant is possible or not should be decided by the plastic surgeon and the consent for undergoing the procedure to be given by the patient. I usually examine the amputated part under magnification with a microscope to see the status of the artery and veins to decide if the amputated part can be reattached. Once I decide that a reimplant is possible, I let the family and patient know what the chances are, and they can decide further. The procedure itself takes 8-12 hours usually or longer. It involves the repair of arteries, veins, nerves, tendons, and bones, all in one go.
The patient needs to stay in the hospital for the next 5-7 days for monitoring. Re explorations may be done in case vascular anastomosis fails while staying in the hospital.