Talal Altuwaylie et al, 2020;4(8):1169–1171.

International Journal of Medicine in Developing Countries

https://doi.org/10.24911/IJMDC.51-1590779954

ORIGINAL ARTICLE

Replantation: factors maximizing the

functionality of a replanted body part
Talal Altuwaylie1*, Faisal Yonbawi1, Ahmed Basabrain1, Bader Ibrahim1,
Al-Baraa Albawab1

ABSTRACT
Replantation is a surgical operation to reattach an amputated body part. The probability of success is greater
for a limb that has been amputated by a sharp-cut injury than by a crush injury. This varied success rate indi-
cates that certain factors can help to restore the functionality of the replanted body part. These factors can
be categorized as preoperative, procedural, and postoperative. Preoperative factors include the process of
determining the possibility of performing replantation, as well as the time elapsed between the incidence of
amputation and the performance of the surgery. Procedural factors affect the surgical process, and include
the skills of the surgical team. Postoperative factors include physical therapy, rehabilitation, the psychological
aspect of recovery, and other factors occurring after the surgical operation. Each of these factors plays a role in
restoring the functionality of the limb to the pre-amputation level. A study by King Khalid University Hospital
demonstrated the importance of these factors in the level of functional recovery achieved after follow-up care
for a specific period.
Keywords: Amputation, factors, functionality, replantation.

Introduction lead to defects in functionality [6]. On the contrary, a

Amputation can be defined as the surgical or traumatic
detachment, either total or partial, of a body part.
Traumatic amputation is not a rare injury, and its
consequences—which are typically severe—may include
psychological changes, permanent functional defects, and
the inability to handle work demands [1,2]. Furthermore,
amputation often results in significant financial losses,
both directly and indirectly, to the patient and to society
at large [3]. Under certain circumstances, an amputated
limb can be surgically reattached through a microsurgical
operation that primarily aims to maximize recovery of
the functionality of the replanted limb; this surgical
operation is known as “replantation” [4]. Maximizing the
retrieval of functionality is dependent on preoperative,
procedural, and postoperative factors, alongside certain
other considerations [5].
guillotine injury, also known as a “sharp-cut injury”, has
a better chance of achieving successful replantation [6].
However, the ability to perform replantation also depends
on the patient’s overall condition and the time elapsed
between the injury incidence and the resultant medical
response [5]. For example, severe injuries may prevent
the quick assessment of the probability of success for
replantation surgery, creating an unfavorable extension
of the time elapsed between the incidence of the injury
and the performance of the surgery. Too much time
causes further damage to the amputated limb, including
vascular changes like hardening of the arteries [5]. Proper
preservation of the amputated limb will increase its
resistance to the early development of ischemia. Proper
preservation also decreases the vulnerability of the
amputated limb to infections despite the absence of blood
circulation [5]. One means of preserving an amputated

Review

Preoperative factors include the assessment of whether

replantation of the amputated limb is possible at all. One
consideration is the mechanism of injury, which can be
either a crush injury or a guillotine injury [5]. A crush injury
to a limb lessens the likelihood of successful replantation
surgery because such an injury often causes major tissue
damage. Furthermore, successful replantation of a
limb amputated through a crush injury will most likely
Correspondence to: Talal Altuwaylie
College of Medicine, King Saud Bin Abdulaziz University
for Health Sciences, Jeddah, Saudi Arabia.
Email: ttalal40@gmail.com
Full list of author information is available at the end of
the article.
Received: 29 May 2020 | Accepted: 11 June 2020

© IJMDC. https://www.ijmdc.com 1169

 Replantation
limb is to place it inside a plastic bag containing normal
saline [6].
Procedural factors, such as quick and accurate
performance of the surgical operation, the presence of a
skilled surgical team, and ensuring a high level of hygiene
for the damaged tissue, are all critical in predicting the
functionality of a replanted limb [7]. For instance, good
surgical skills and thorough experience in microsurgery
are required to perform a successful replantation and
to avoid other complicated secondary procedures [8].
Moreover, an unfavorable extension of the duration of
the surgical operation may result from complications
when the amputation of multiple individual digits occurs.
The longer it takes to complete the surgical operation,
the greater the vulnerability of the limb to infection
[6]. The surgical team must keep the damaged tissue of
the amputated limb clean during the surgery to avoid
infections [6].
Postoperative factors that facilitate recovery and increase
the functionality of replanted limbs include physical
therapy, rehabilitation, the patient having a healthy
lifestyle, follow-up care, and the psychological aspect
of recovery [9,10]. For instance, putting the patient
under observation for the first 2 days is necessary to
control side effects that may appear during recovery [6].
Blood-thinning medications are given to the patient to
prevent the formation of clots [5,6]. Physical therapy
and rehabilitation are crucial for achieving progress in
both recovery and functionality of the replanted limb.
For example, certain exercises aid in preventing joint
stiffness, facilitating muscle movement, and reducing
scarring [9]. The duration of a patient’s physical therapy
and rehabilitation depends on the nature of the injury
[9]. Furthermore, the patient can play their own role
in facilitating recovery. For instance, smoking and
caffeinated beverages should be avoided to prevent a
reduction in blood flow to the replanted limb. It is also
crucial that the replanted limb be protected before the
patient leaves the hospital [11]. For example, the surgical
site should be wrapped in a bandage to prevent infection
and decrease swelling [6]. The psychological aspect of
recovery is also important, and care must be taken after
the surgery to ensure the patient’s mental well-being.
For instance, the patient may suffer emotional trauma
when seeing the replanted limb for the first time after the
removal of bandages. Also, the patient may feel shocked
or disappointed in the probable event that the replanted
limb does not appear as it did before the incident [12].
Staff at King Khalid University Hospital reviewed 70
patients who recovered from traumatic limb and digit
amputation after thorough follow-up care that lasted from
April 1984 until April 1988 [7]. Unfortunately, replantation
was not a viable option for 34 of the 70 patients. The other
36 patients underwent replantation or revascularization
of 46 discrete body parts. The net rate of survival was
67.4%. The net rate of survival increased from 62.8% to
81.8% during the subsequent 2 years, and an indication
of functional recovery was reported in 18 cases. This
1170
remarkable increase in the net rate of survival and the
reported functional recovery mainly resulted from two
factors: a change in the specificity of the criteria used
when selecting cases where replantation is possible and
improvement of the technical skills of the surgical team [7].
Conclusion
Amputation of a limb may result in severe psychological
harm, significant loss of physical functionality, as well
as severe financial losses, both directly and indirectly.
However, these serious consequences may be avoided or
mitigated by successful replantation surgery. The primary
factors that determine the functionality of the replanted
limb can be classified into preoperative, procedural, and
postoperative factors. Preoperative factors include the
type of injury, maintaining the amputated limb at a high
level of hygiene, and preserving the amputated body part
until the time it can be reattached. Procedural factors
revolve around surgical skills, the experience of the
surgical team, as well as quick and accurate performance
of the surgery. Postoperative factors include the patient’s
psychological condition after surgery, as well as physical
therapy, rehabilitation, healthy lifestyle practices on the
part of the patient, and constant follow-up care. Each
factor can have a significant influence on the functionality
level of the replanted limb. A local interventional
study conducted at King Khalid University Hospital
demonstrated that a significant increase in the net rate of
survival for replantation operations was associated with
the technical skills of the surgical team and improvements
in the selectivity of the criteria used when evaluating the
possibility of performing replantation.
Conflict of interest
The authors declare that there is no conflict of interest
regarding the publication of this article.
Funding
None.
Consent for publication
Not applicable.
Ethical approval
Not applicable.
Author details
Talal Altuwaylie1, Faisal Yonbawi1, Ahmed Basabrain1, Bader
Ibrahim1, Al-Baraa Albawab1
1. College of Medicine, King Saud Bin Abdulaziz University for
Health Sciences, Jeddah, Saudi Arabia
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