“My son is 23, and I keep my power saw hidden so that he has to ask for it. “Even with a great prognosis, this is a serious thing,” Wint says. The final steps are the reattachment of nerves and skin. For every artery he sews, Wint makes it a practice to reattach two veins to ensure adequate blood flow as well as proper drainage. Then come arteries and veins, which are arguably the most challenging aspect of the procedure, requiring a 10X microscope.īlood vessels are hollow and difficult to stitch, and veins in particular can easily collapse or tear. It will need shortening, and in the case of a jagged break, the surgeon will shave both sides before inserting pins or wires or a combination of the two. The first section actually reattached is bone. This is the final opportunity to ensure that every component is viable and that the blade’s path wasn’t too destructive for a successful outcome. Two teams are required-one for the recipient and one for the finger-and afterward the patient will need to recover in an intensive care unit, along with weeks, or even months, of rehabilitation.īefore the replantation begins, the surgeon will identify and tag all relevant tendons, arteries, veins, and nerves. The procedure itself, a four-to-five-hour microsurgery, is complex. For example, reattachment surgery will almost always be attempted for a thumb. Age, general health, and whether he or she is a smoker are all important considerations, along with the level of disability presented by the finger’s absence. “If someone cuts off their index, middle, and ring finger, and the index is badly damaged, but the ring finger is OK, a surgeon might relocate the ring finger to the index position,” Wint explains. This can lead to more creative solutions. The condition of the severed digit needs to be assessed as well, since without proper storage, it’s no longer viable after six hours.Īnother variable lies in the number of fingers involved or whether multiple injuries have occurred on the same digit. The width of the saw kerf is also important because a cleaner, narrower cut creates less tissue damage. Conversely, proximal wounds, closer to the base of the finger, involve severed tendons and sometimes are an indicator not to replant. Generally, distal injuries-those at the fingertip or near the first knuckle-are simpler to repair. Many will also experience a diminished range of motion and increased sensitivity to cold. In addition, even when a digit is successfully reattached, all patients will have some loss of sensation. In a total of 556 cases, only 16 percent were able to receive replantations. Indeed, one study conducted by the University of North Carolina, Chapel Hill, looked at every hospital admission for finger amputations statewide during 2004–2005. “If you’re a 55-year-old smoker with a single finger severed near the base, I’m probably not going to do that surgery.” “Fingers reattached at a good facility are 80 to 90 percent successful, but that doesn’t include all of the people who are not candidates for the surgery,” says Wint, who is also a hand and orthopedic surgeon in Springfield, Mass. Instead, the relevant statistic is how many replantations are attempted. Jeffrey Wint, a spokesperson for the American Academy of Orthopedic Surgeons. But that’s the wrong question to ask, says Dr. Many people wonder how likely it is that finger reattachment surgery will have a successful outcome. This is a sidebar to our exclusive feature on flesh-sensing technology and what it means to the remodeling industry.
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