Indications and surgical techniques for digit replantation

Finger amputations are devastating, life-changing injuries. They can occur from many different types of injury, but most often are caused by power tools or machinery in the workplace. Modern microvascular surgical techniques have enabled surgeons to successfully reattach fingers that have been amputated at almost level of injury. Patient outcome and digit viability have improved as surgeons have gained more experience with microvascular techniques, and have narrowed the operative indications for replantation. Currently, replantation is recommended for amputated thumbs, multiple digit amputations, and single digit amputations distal to the FDS insertion, as well as all amputations in children. Replantation surgery is technically demanding. Success relies on patient selection, meticulous operative technique, and postoperative monitoring. Most patients have successful outcomes with at least protective sensation and useful range of motion in the replanted digit. Though complications, including joint stiffness, tendon adhesions, malunion, and cold intolerance are not infrequent, patient satisfaction following replantation is high.