Dr. Sumit Saxena, Plastic and Cosmetic Surgeon from Inamdar Hospital re-implants Multiple fingers. Multiple fingers re-implants that too at a distal level (in this case middle of proximal phalanx) is a tricky and a difficult operation. With the advancement of micro-surgery, it is now possible to replant a totally amputated finger by restoring blood supply and repairing tendons, nerves, bones etc. Dr. Sumit Saxena at Inamdar Hospital has successfully replanted amputated fingers. The fortunate person was Gopal Pansare(70yrs, male) from Baramati. He was injured while working in farm with his machine on Sunday26thJan2019.Accidentally all his fingers got injured and amputed that at the level of middle of the proximal phalanx. Only little finger remained hanging by thin skin. After getting first aid from a private hospital, he was brought to Inamdar Hospital, Fatima Nagar at 5 pm on the same day under Dr. Sumit Saxena. Her amputated parts were immediately preserved in the cold storage. Their plant procedure was started immediately. While the necessary investigations and later an esthesiatothe patient was being given Dr.Saxena started with the operation of amputed parts without wasting time. The procedure took 11 hours and finished on Monday at 4.30am.Along with Dr.Saxena, the team of Dr.Jyoti Sawant anesthetist, Brother Sreerag and Sister Archana were there throughout the surgery. The patient was discharged after a week. At the time of discharge, there were already movement in the fingers.The patient was advised on the need for regular follow-up to assess the vascularity,bonyunion, range of motion, and nerve recovery. Further procedures that may be required for the tendons including tenolysis/transfers, neurolysis for the nerves, and prolonged physiotherapy during the next 1 year have been explained to the patient. The patient was discharged after a week. At the time of discharge, there were already movement in the fingers.The patient was advised on the need for regular follow up to assess the vascularity,bonyunion, range of motion, and nerve recovery. Further procedures that may be required for the tendons including tenolysis/transfers, neurolysis for the nerves, and prolonged physiotherapy during the next 1 year have been explained to the patient. Since then many severed body parts have been reattached, preserving the quality of life of patients through improved function and appearance.The success of the operation depends on factors like nature of the injury such as crush or sharp cut injuries, warm ischemic time(duration between time of amputation and time of replantation), age of the patient, smoking habit, pre-existing diseases like diabetes, site of injury, contamination etc. Basic first-aid should be given immediately. The injured hand should be wrapped in a clean dressing and elevated with direct pressure applied to limit bleeding. Attempts to ligate arterial bleeding should be avoided,as this result in further injury to the vessels. The amputated part should be retrieved, even if it appears unlikely that replantation is possible. Ideal warm ischemic time is 6 hours. But it can be lengthened to 12 hours by wrapping the amputated part in a saline-moistened gauze sponge placed in a plastic bag. The plastic bag should be sealed and placed in a container of ice. The amputated part should never be placed directly on ice because this could result in frostbite injury to the vessels. The part should also never be immersed in water which makes digital vessel repair more difficult and less reliable. The time can best still lengthened in cases related to children. When considering multiple-finger replantation, the finger with the best chance for successful replantation, best-expected recovery, and most significant contribution to function should be repaired first.If all the fingers are injured equally and have the same chance for successful repair, the order of repair should be the middle finger first, then index, then ring, and lastly the small finger. The replanted part never regains 100% of its original use, and most doctors consider 60% to 80% of use an excellent result. Good communication between the replantation center’s micro surgeon Dr.Sumit Saxena and the referring physician is paramount to achieving appropriate and timely referrals and correct transport of amputated parts. Communication with patients is also important. Possible candidates for replantation must be informed of the likely outcomes of replantation and revision amputation procedures, and the different postoperative regimens for each. For patients who choose revision amputation or whose replants do not survive, there are a variety of reconstructive options available, if necessary, such as immediate cover with groin flap or later on with toe-to-hand transfer. For emergency transportation, urgent ambulance service is needed if the incident happens in a remote location away from tertiary centre like Inamdar hospital to salvage the amputed part. For a patient, remember that quality of life is directly related to your attitude and expectations—not on just regaining limb use. Even with the best medical care, you need to be strong during the course of recovery. Stay in the flow of life. You have many great gifts.
