how does a cut finger get resewn back on with full functionality?
In: Biology
Plastic/hand surgeon here. Replants are generally repaired structure by structure, although in some situations digit by digit. Everything is washed and debrided. Then a couple incisions are made and the skin lifted back and the blood vessels, digital nerves, flexor/extensor tendons are exposed. This is done for the amputated finger and for the stump, and if possible 2 teams work simultaneously to save time.
Order of repair is usually: bone (k wires), flexor tendon, extensor tendon, artery, nerve, vein, skin.
Arteries, veins, and nerves are very small in the finger (1-2mm diameter), so usually use an operating microscope.
During healing, scarring causes the tendons to stick like glue, so most patients require another operation to free them up later. Replanting a single-digit amputation is traditionally considered relative contraindication, as the stiffness and poor sensation may actually decrease hand function rather than help it (except for thumb, which you’d try to salvage whenever possible).
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