Digital replantation including postoperative care.

Digital replantation first became a reality in the 1960s with the advent of microsurgical techniques. Indications for replantation have evolved over the ensuing years and currently include 1) thumb amputations, 2) multiple digit amputations, and 3) amputations in children. Crush and avulsion injuries and amputations of a single digit proximal to the flexor digitorum superficialis insertion remain relative contraindications. Good communication between the replantation center microsurgeon 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 toe-to-hand transfer. The techniques to perform such elective free tissue transfers have been perfected during the last 30 years largely from experience gained through digital replantation.