Re-implantation of avulsed,
amputated thumb, fingers & foot
First successful thumb re-implantation was performed in 1965 by Komatsu and Tamai. Since then, continuous advances are taking place in digital re-implantations. Also the patients demand for re-implantation of their amputated parts, regardless of the nature of their injuries or the condition in which fingers were transported. The surgeons must be able to comply with this demand and provide results that will be satisfactory in the terms of function and appearance. In avulsion injuries of digits and thumbs, both vessels and nerves are damaged. Usually it is not limited to the site of amputation and on closer inspection of part, one may discover structures dangling from its cut end. These may be tendon or nerves, but rarely vessels. Vessels in this condition are commonly avulsed distally. Viability in such amputated part can be successfully restored either by bone shortening or by use of vein grafts.

Transportation and Ischaemia time of
an amputated stump
Amputated part can be successfully transported to micro-vascular unit by wrapping the amputated stump in saline soaked pad or gauze. This stump should be put in a polythene bag and this bag is put into another polythene bag filled with ice. So the amputated stump will not come in direct contact with ice. Stump should not be put directly into water or saline solution to prevent maceration.

Normally with such method, amputated digits or thumb remain viable for more than 20hrs. (cold ischaemia time). If amputated stump of digit is not kept in ice, even then it will remain viable for more than 12hrs, (warm ischaemia time).

Re-implantation of thumb
The patient Mr. Dambar Rana, had crush and avulsion injury of Rt. thumb just distal to Metacarpo-phallangeal joint. Patient came well within warm ischaemia time carrying the amputated stump and dangling tendons avulsed at level of distal forearm from musculo tendinous junction. This thumb was successfully re-implanted by doing 1.5 to 2cm shorting of bone distal to M.P joint. In this one artery and two veins were anastomosed without any vein graft. A single digital nerve was also successfully anastamosed. Patient had complete functional recovery of Rt. thumb.

Re-implantation of thumb

Re-implantation of Foot
Mr. Shahwaz Khan, 12 yrs old child was brought from Saharanpur with both fore feet amputated. Patient reached the hospital 8-10hrs after injury with both feet well kept in ice bags and wrapped in saline soaked gauze. Rt. forefoot was successfully re-implanted with all vessels, tendons and nerves repaired. And in other limb, amputated stump of foot was covered with a neuro sensory free flap. Patient had complete sensory and functional recovery of Rt. foot. Now after 4 months, patient can walk on his own feet.

Re-implantation of foot

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