Our Summary

The success rate of reattaching severed fingers or toes (known as digital replantation) varies across different regions and countries. Surgeons in Asia often deal with more complex cases and have developed unique approaches. The procedure can be done on multiple fingers or toes at once, either by focusing on each one individually or by treating the entire structure of the hand or foot. For procedures involving all 10 fingers, it’s best to have 3 or 4 surgical teams working together. Special techniques, like flow-through flaps (often using veins), can be used to fix soft tissue and artery damage. These can be taken from the lower arm or lower leg. Additionally, a specialized flap from a nearby finger or toe can also be used to fix tissue damage and provide blood flow to the reattached digit. The paper also mentions the use of awake surgery.

FAQs

  1. What are the different methods employed in digital replantation?
  2. What is the role of flow-through flaps in digital replantation?
  3. How can a pedicled digital artery flap be used in digital replantation?

Doctor’s Tip

A doctor might advise a patient undergoing a hand transplant to follow their post-operative care instructions carefully, including attending regular follow-up appointments and adhering to any prescribed medications. It is also important for the patient to participate in physical therapy to help regain strength and function in the transplanted hand. Additionally, the patient should avoid activities that could put excessive strain on the newly transplanted hand to ensure a successful recovery.

Suitable For

Patients who may be recommended for a hand transplant typically include those who have experienced severe trauma or injury resulting in the loss of one or both hands. This can include individuals who have lost multiple digits or have extensive tissue defects in the hand. Additionally, patients who have not had success with other reconstructive surgeries or who have functional limitations due to their hand injury may also be considered for a hand transplant. It is important to note that hand transplant surgery is a complex procedure and not all patients may be suitable candidates. Each case is carefully evaluated by a team of healthcare professionals to determine the best course of treatment for the individual patient.

Timeline

Before hand transplant:

  1. Patient suffers severe hand trauma, leading to loss of one or both hands.
  2. Patient undergoes evaluation by a transplant team to determine if they are a suitable candidate for a hand transplant.
  3. Patient undergoes extensive physical and psychological evaluations to assess their overall health and readiness for surgery.
  4. Patient is placed on a waiting list for a suitable donor hand.

After hand transplant:

  1. Hand transplant surgery is performed, which can take several hours to complete.
  2. Patient undergoes intensive rehabilitation and physical therapy to regain function and strength in the transplanted hand.
  3. Patient takes immunosuppressant medications to prevent rejection of the transplanted hand.
  4. Patient undergoes regular follow-up appointments with their transplant team to monitor the success of the transplant and address any complications that may arise.
  5. Patient gradually regains function in the transplanted hand and is able to perform daily activities with increasing independence.

What to Ask Your Doctor

Some questions a patient should ask their doctor about hand transplant may include:

  1. Am I a candidate for a hand transplant?
  2. What are the risks and potential complications of a hand transplant?
  3. What is the success rate of hand transplants?
  4. What is the recovery process like after a hand transplant?
  5. How long will it take for me to regain function in my transplanted hand?
  6. Will I need to take immunosuppressant medication after the transplant?
  7. How long will I need to stay in the hospital after the surgery?
  8. What type of rehabilitation or physical therapy will I need after the transplant?
  9. Are there any long-term considerations or limitations I should be aware of with a hand transplant?
  10. How many hand transplants have you performed and what is your experience with this procedure?

Reference

Authors: Tang JB, Wang ZT, Chen J, Wong J. Journal: Clin Plast Surg. 2020 Oct;47(4):437-459. doi: 10.1016/j.cps.2020.06.002. PMID: 32892794