FINGER AND EXTREMITY AMPUTATIONS
Amputations are divided into two groups as total and partial amputations. In total amputations which are completely seperated from the body, at least all severed vessels must be repaired soon after the incident. Otherwise, the survival of that bodypart is not possible. In some cases, continuity of the organ is still available with the body. These amputations are named as ‘’partial amputations’’. Sometimes the connection of the bodypart contains enough vessels for its survival, but sometimes it doesn’t. The latter ones should be handled like total amputations and definitive surgery should be performed in hours. ‘’Replantation’’ is a term, indicates to suture back the severed organ reconnecting its vessels on its own place. In some cases replantation is not possible due to general health status of the patient, late arrival to replantation center, inappropriate status of amputated part etc.
If the patient has acompanying injuries, priority should be given for vital ones. Under these circumstances, replantation surgery could be cancelled. On the other hand, if the severed part too much damaged, replantation may not be performed. The success rate of surgeries in amputations with sharp cutters like knife, chopper etc. is higher than in amputations happened by pulling or compression.
Additional conditions such as smoking, diabetes, chronic heart diseases or high blood pressure may affect the treatment adversely. Also, the rate of success is less in older patients due to degenerative changes in vascular structures.
If amputation level is above the wrist it should be replanted in 2 to 4 hours. This critical period may increase upto 6 to 12 hours if the amputation level is between wrist and fingertip. The length of this time interval that gives the opportunity for replantation depends on how much muscle tissue the amputated part contains. This why, the patient should be transported to the hospital in cold environment as soon as possible. The level of amputation, the quality of technical equipment and the experience of microsurgery team are other important, determining factors on the success of replantation. Again, all these factors determine how long the procedure lasts.
Recovery period may vary between 2 months and 2 years according to the level of severance. Also further may be required to provide after the severed part is kept alive. As usual in hand surgery, physiotherapy is utmost important for functionally good result.