Vehicular accidents and other devastating events can sometimes lead to fatal injuries such as a complete amputation of a part or the whole of the limb. When the entire limb is involved, it is known as a major amputation. When only part of the limb such as the fingers or toes is involved, it is a minor amputation.
The prognosis of major amputations is poor, and without prompt surgical replantation, salvation is almost impossible. Major amputations can involve the entire arm, forearm or the hand to be severed off. Without the blood supply reaching the many groups of muscles, the amputated area only has a few hours to survive.
Surgery for Major Amputation
Emergency surgery is the only hope for patients with major amputations; the outcomes are seldom satisfactory if there is a delay. This surgical procedure involves re-establishing the blood circulation of the amputated part by constructing a shunt and forming an anastomosis between the stump and the severed part.
The amputated part is then cleaned and debrided, the broken bones and torn tendons are then shortened and repaired respectively. Under the microscope, the nervous and vascular connection is reestablished, and skin grafts are used to cover the area of amputation.
Surgery for Minor Amputations
Minor amputations can involve part of the limb such as the fingers. These amputations are less fatal and are easier to surgically correct. Restoration of appropriate function is also possible in most cases.
As with major amputations, it is important to operate within a few hours (4-6) of the injury before the blood supply is cut off. The surgery comprises of reforming a blood circulation and surgical reconstruction of the tendons. Repair of the vessels and nerves under the microscope is challenging in minor amputations because of the small size of the nerves and vessels involved.
It’s important to realize that not all replantation surgeries succeed. The outcome is highly dependent on the fitness of the amputee and the nature of the injury sustained. Generally grinding or crush injuries have a poorer outcome than sharp injuries. Also, younger patients have a better chance at recovering faster and better than the elderly.
What Are the Alternative Options?
If replantation surgery fails, reconstruction surgery may be a good second option to consider. This procedure involves reconstructing a lost finger with a toe or the finger of the less dominant hand.
Modern Prostheses are also now an excellent option for amputees.