Reconstructive Surgery
Hand surgery and limb replantation
The hand carries more function per square centimetre than any other part of the body. Losing a finger affects not only appearance but grip, work and every detail of daily life. Microsurgery makes it possible to reattach severed limbs and rebuild lost function.
Written and medically reviewed by: Doç. Dr. Tahsin Oğuz Acartürk — Plastic, Reconstructive & Aesthetic Surgery; University of Pittsburgh. Last updated:
What to do first in a limb amputation
The success of replantation depends directly on what is done in the first hours. If the amputated part is preserved correctly, the window can extend to 12 hours at finger level in cooled tissue; for amputations above the wrist, which contain muscle, it is under 6 hours.
How to preserve the amputated part
- Wrap the part in clean, slightly moist gauze
- Place it in a waterproof bag and seal it
- Put the bag into a container of iced water
- Do not let the part touch ice or water directly — the tissue will freeze or swell
- Control bleeding with firm pressure using a clean cloth; do not apply a tourniquet
This page is not a substitute for emergency medical care. In a limb amputation, call emergency services immediately and ask to be directed to a centre able to perform replantation. Time is the most decisive factor.
Procedures performed
Replantation
Reattachment of an amputated finger or limb. The bone is fixed first, then the artery, vein, nerves and tendons are repaired under the microscope. Amputations of the thumb and of multiple fingers are given priority.
Toe-to-hand transfer
Where a finger cannot be salvaged or is congenitally absent, a toe is transferred to the hand with its vessels and nerves. It restores grip function particularly in thumb loss, and is among the procedures Assoc. Prof. Dr. Acarturk performs frequently on volunteer missions in Vietnam.
Tendon and nerve repair
Microsurgical repair of tendons and nerves in lacerating injuries. Where nerve loss is extensive, a nerve graft is interposed.
Secondary reconstruction
Planned procedures for limitations remaining after initial treatment: tendon transfers, release of contractures, soft tissue reconstruction and joint corrections.
The decisive role of rehabilitation
In hand surgery, the operation is only part of the result. Repaired tendons adhere if left immobile, joints stiffen and function does not return even if the nerve recovers. Hand therapy therefore begins within days of surgery and continues for months.
- Protected motion exercises in the early period
- Oedema control and scar management
- Sensory re-education — the brain relearning as the nerve recovers
- Gradual building of grip strength
A replanted finger surviving does not mean function has returned. The true measure of success is whether the hand becomes usable again in daily life — and that depends on rehabilitation as much as on surgery.
Frequently asked questions
Within how many hours can an amputated finger be reattached?
With correct cold-chain preservation, the window can extend to 12 hours for finger-level amputations. For amputations above the wrist containing muscle it is under 6 hours, as muscle is far more sensitive to ischaemia.
Can every amputated part be reattached?
No. Replantation may not be appropriate in crush injuries, amputations at multiple levels and where the tissue is heavily contaminated. The patient's general condition and associated injuries also influence the decision.
Will the reattached finger work as before?
A full return to previous function is rare. The goal is a finger that contributes to grip, has partial sensation and is pain-free. The outcome depends on the level of amputation and on rehabilitation.
Will taking a toe affect my walking?
Removal of the second toe does not meaningfully affect walking. Supported walking is needed in the first weeks, after which normal activity resumes.
When will sensation return after nerve repair?
A nerve advances roughly 1 mm per day. Reaching the fingertip from the repair site can take months; the quality of sensation depends on age and the type of injury.
Doç. Dr. Tahsin Oğuz Acartürk
Plastic, Reconstructive & Aesthetic Surgery · Oral & Maxillofacial Surgery · University of Pittsburgh
Experience in this field: Hand surgery and replantation have been among Assoc. Prof. Dr. Acarturk's areas of intensive work since his residency. He gained comprehensive experience in hand surgery, limb amputation and complex injuries at the University of Pittsburgh, and performs toe-to-hand transfer and brachial plexus surgery on volunteer missions in Vietnam.
- Hand surgery and replantation practice at the University of Pittsburgh
- Toe-to-hand transfer on volunteer missions in Vietnam
- Three years of general and vascular surgery training
Hand surgery assessment
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