Saving the Amputated Digit and Hand

Indications for replantation of fingers and hands are discussed. Success has been achieved in guillotine and moderate crush injuries but avulsion injuries have presented problems. A brief outline of the technical approach and postoperative management is given. Twenty cases, involving 27 incomplete and completely amputated digits, have been treated. All 8 incompletely amputated ischaemic digits have survived and 13 of 19 totally amputated digits were successfully replaced. In addition, 2 completely amputated hands and 1 incomplete and 1 complete below elbow amputation have survived. Secondary surgery has been completed on the majority of patients with Improved function and return to work. A long-term evaluation of hand function is necessary but the present results are encouraging, particularly in nerve regeneration. The organizational aspect of a replantation team together with first-aid instructions are included, and the value of a multidiscipline type research programme stressed.