Microsurgery in Hand Reattachment

When a person loses a hand or finger in an accident, the impact goes far beyond the physical injury. It deeply affects the victim's ability to work, communicate, and live independently. Thanks to modern advances in microsurgery, doctors can now reattach severed hands and fingers, giving patients a renewed chance at leading functional lives. Often described as the “art of precision,” microsurgery involves surgeons working under powerful microscopes, using tools finer than a strand of hair to carefully reconnect arteries, veins, and nerves that are only a few millimeters thick.

Before the surgery begins, surgeons must assess whether the severed hand can actually be reattached. Clean, sharp amputations, often caused by tools or machinery, usually have a high chance of recovery. However, crush or avulsion injuries are less likely to succeed because of extensive tissue damage. Time is also critical as muscles and soft tissues can only survive a few hours without any blood flow, so the severed part must be cooled and protected from contamination. Once in the operating room, the surgeon removes damaged tissue, stabilizes the bones with wires or plates, and meticulously repairs the tendons. The entire process can last 8–12 hours depending on the complexity of the injury and the number of structures that need to be reconnected.

Restoring circulation determines whether the hand survives. Repair in the arteries allows oxygenated blood to re-enter the tissue, while vein repairs ensures that blood can flow out properly. If either of these steps fails, the tissue becomes restricted of oxygen, known as ischemia, and begins to die. Even when the replantation goes smoothly, recovery can take months or even years. Sensation and movement gradually return as the nerves regrow and muscles adapt.

Over the past 3 decades, survival rates for reattached hands have improved. A large review reports that around 80-90% of reattached hands survive if blood flow is restored promptly and the injury is clean. However, only about 40% of patients fully regain normal sensation in their fingers. Achieving recovery depends not only on the surgery, but also depends heavily on postoperative rehabilitation. Intensive physical therapy beginning within days of surgery significantly enhances motor outcomes by reducing stiffness and promoting neuromuscular recovery, allowing patients to gradually regain strength and fine motor control.

Despite these advancements, complications remain a persistent challenge. In postoperative recovery, complications such as arterial blood clots, infection, or venous congestion (pressure buildup in veins causing leakage) can occur. Over time, patients may also experience sensitivity to the cold, limited motion, or nerve-related pain. Personal factors such as age, smoking, or health conditions (e.g. diabetes) can further influence the outcome of recovery. Studies show that those who undergo successful hand replantation, compared to people using prosthetic limbs, usually report greater satisfaction, improved daily function and higher confidence in their own bodies.

by Shanisse Tan at Incisionary

APA References

Serafin, Donald M.D.. Microsurgery: Past, Present, and Future. Plastic and Reconstructive Surgery 66(5):p 781-785, November 1980. 

Mai, T. T., Nguyen, T. N., Phan, T. D. L., Vo, K. H., & Nguyen, P. D. (2024). MICROSURGICAL REIMPLANTATION OUTCOMES FOR COMPLETE AND INCOMPLETE AMPUTATIONS OF DISTAL PHALANGES OF FINGERS. Orthopedic reviews, 16, 94566. https://doi.org/10.52965/001c.94566

Zhegang Zhou, Longbiao Yu, Fanbin Meng, Jingjing Wen, Yingfeng Xiao, Bo Zhou, Shengxiang Wan, Hui Zeng, Fei Yu, Replantation of multiple fingertip amputations using super microsurgery: A case report and literature review, JPRAS Open, Volume 40, 2024, Pages 245-252, ISSN 2352-5878, https://doi.org/10.1016/j.jpra.2024.03.008. 

American Society for Surgery of the Hand. Arm, Hand, and Finger Replantation. https://www.assh.org/handcare/condition/hand-arm-finger-replantation 

American Society For Surgery of the Hand. Microsurgery In Hand Surgery: What It Is & Why It Matters. https://www.assh.org/handcare/blog/microsurgery-in-hand-surgery-what-it-is-why-it-matters 

Biemer, E., & Duspiva, W. (1977). Komplikationen bei der Replantation abgetrennter Gliedmassen [Complications in the replantation of amputated digits]. Handchirurgie, 9(2), 67–70.

Kim, D. H., Kwak, S. H., & Lee, S. H. (2022). Forearm replantation: Pearls and pitfalls. Archives of Hand and Microsurgery, 27(2), 171–179. https://doi.org/10.12790/ahm.22.0006 

Sabapathy, S. R., & Satbhai, N. G. (2014). Microsurgery in the urgent and emergent management of the hand. Current reviews in musculoskeletal medicine, 7(1), 40–46. https://doi.org/10.1007/s12178-013-9197-4 

Deborah B. Martins, Ogi Solaja, Gregory Buncke, Efficient Replantation: Techniques, Tricks, and Secondary Procedures for Improved Functional Outcomes, Journal of Hand Surgery Global Online, Volume 7, Issue 2, 2025, Pages 331-339, ISSN 2589-5141, https://doi.org/10.1016/j.jhsg.2024.07.010.