Replantation

Replantation is viable reattachment of completely separated part of the body –no connection exist between the body & separated part ,the body & amputated part can be separated miles apart. Revascularization  is repair & establishing the vasularity of part that has been incompletely amputated.

With the advent of good Microsurgical  instruments ,fine non reacting suture materials & many training centre giving training for microsurgical expertise , replantation is being carried out regularly. In the present scenario  success rate of 90% is being achieved in properly indicated cases as far as viability is concerned.

Proper preservation & transportation of part, from the accident site to replantation surgeon is very important as there is considerable difference in success rate with cold ischemia v/s warm ischemia time & properly preserved v/s improperly preserved part.

How to transport the part from the site of accident is very critical for result .A Â wrongly preserved part will give a poor result or failure & proper preservation increases the chances of survival & good function.

The principles of transportation of the amputated part

First & fore most thing is to take life saving measure for the patient first ,start fluid replacement immediately & then do the limb preservation measure.

Fig: Give adequate compression to the amputated stump to prevent the bleeding  .

Direct the attention towards amputated portion .Do not try to clean the part . Soak a gauze in ringer/saline & then wrap this gauze around amputated part.

Send the patient & this box to the nearest centre where facility for replantation is available. Throughout the period continue to monitor the vitals of patient. Inform to the team leader of replantation team ahead of time so by the time patient is there, he is ready with his team members & the operation theatre is also ready.

One should not put the amputated part directly  into the ice, which does freeze drying of part with thermal coagulation of tissue & also the part should never be directly put in to plain water which will cause individual cells to swell up because of osmotic migration of water in to the part. These two things render the part not worth replanting.