What is Arm Amputation and Replantation?

Arm amputation refers to the severing of the arm as a result of a traumatic injury or surgical removal of the arm as a result of a disease condition. Replantation is a complex microsurgical procedure in which the severed or separated arm part is replanted or reattached to the body to restore arm function and appearance.

Replantation is more common for upper limbs and may include reattachment of any of the arm parts, such as the fingers, wrist, and forearm. It is less common for lower limbs. At the time of replantation, surgeons often repair damaged bony structures as well as nerves, blood vessels, tendons, and skin. Surgeons may also need to repair additional soft tissue coverage.

Indications for Arm Amputation and Replantation

Arm amputation and replantation is typically indicated for traumatic injuries of the arm, such as an arm caught between heavy machinery during working, which can completely sever connections between parts of the arm such as a finger and hand or a hand and wrist. These types of injuries are critical and are regarded as surgical emergencies. In order to prevent tissue loss or death of tissue (necrosis), surgeons must restore blood supply to the amputated arm part within hours of the injury.

Preparation for Arm Amputation and Replantation

In general, preparation for arm amputation and replantation may involve the following steps:

• A thorough examination by your doctor to check for any medical issues that need to be addressed prior to surgery.
• Diagnostic tests such as blood work and imaging to help detect any abnormalities that could compromise the safety of the procedure and to plan the surgery.
• You will be asked if you have allergies to medications, anesthesia, or latex.
• You should inform your doctor of any medications or supplements you are taking, or any serious medical conditions such as lung or heart disease.
• You may need to refrain from certain medications such as blood thinners and anti-inflammatories, or any supplements for a week or two prior to the procedure.
• Refrain from smoking or alcohol for a defined period before surgery and several weeks after, as it can hinder post-surgery healing process or impact the surgery.
• You should not consume any solids or liquids at least 8 hours prior to the procedure.
• You should arrange for someone to drive you home after the surgery.
• A signed informed consent form is required from you after the procedure has been explained in detail.

Procedure for Arm Amputation and Replantation

Arm amputation and replantation surgery is usually performed under general anesthesia. Replantation surgery needs extremely specialized medical care. It requires the skills of a highly trained surgeon and an extensive support team in the operating room.

In general, the procedure involves the following steps:

• You will be placed on the procedure table in a position that provides the best operative angle for your surgeon.
• The damaged tissue is carefully removed from the severed or separated part of the arm. The severed part does not have the oxygen, blood supply, or nutrients to nourish the tissue. Hence, progressive tissue injury could have occurred over time requiring debridement. Debridement is the medical term for removal of infected, damaged, or dead tissue to improve the healing potential of the remaining healthy tissue.
• Fractured parts or bone ends are reconnected with fixation devices, such as plates and screws, pins, or wires.
• Nerves, veins, arteries, muscles, and tendons are repaired; in some cases, reconstruction using tissue grafts from your own body (autograft) or tissue grafts obtained from a donor (allograft), or artificial spacers of tendons, blood vessels, skin, and bone may be required, too.
• Finally, after confirming satisfactory repair, the treatment area is sutured and covered with a sterile bandage.

Postoperative Care and Recovery

In general, postoperative care and recovery after arm amputation and replantation will involve the following steps:

• You will be transferred to the recovery room where your nurse will closely observe you for any allergic/anesthetic reactions and monitor your vital signs as you recover.
• You may need to stay in the hospital for several days or weeks to monitor the reconnected part to ensure it is receiving good blood flow. Sometimes, there may be a need to reoperate if a circulation problem occurs to fix the blood flow. Often, medicinal leeches or transfusions are required to help in keeping normal blood flow to the reconnected part.
• You may notice some pain, swelling, and discomfort in the arm area. Pain and anti-inflammatory medications are provided as needed to address these.
• Antibiotics are also prescribed to address the risk of surgery-related infection.
• From the beginning, protective devices, such as braces are utilized to protect the newly repaired part and to enable the patient to move the replanted part.
• You will need to keep your replanted part elevated at all times during the first month to increase circulation.
• You may start rehabilitation or physical therapy regimen as recommended by your surgeon after a specified period to improve range of motion and strengthen arm muscles.
• Instructions on surgical site care and bathing will be provided to keep the wound clean and dry.
• Amputation or replantation can greatly affect your emotional and physical well-being. Talking to your doctor, counselor, or psychotherapist may help you come to terms with the outcome and work through your feelings, so you can move on with your life.
• A periodic follow-up appointment will be scheduled to monitor your progress.

Risks and Complications

As with any surgery, there are some risks and complications that may occur in and around the operated area, including:

• Infection
• Bleeding
• Pain
• Numbness
• Stiffness
• Cold sensitivity
• Loss of use