Replantation is surgery to reattach an amputated finger, thumb or hand.
Note: Surviving is not the same as working.
A replanted digit that stays pink and warm but never regains movement or sensation can be worse for you than a well-healed amputation… which is why the rehab MUST start in week one, ideally day 1, not month three, is the part that decides whether you got your finger back or just kept it.
What the surgeon actually reattaches
In order, usually: bone fixed first, then the extensor tendons, then flexor tendons, then the arteries, then the nerves, then the veins, then skin.
Every one of those structures heals on a different clock, and the rehab has to respect the slowest one without letting the fastest one stick down (adhesion). That tension is the whole discipline.
A thumb gets replanted far more readily than a single finger, because a thumb is around 40% of hand function and a stiff index finger just gets in the way of the others. Multiple fingers and hand-level amputations are also strong candidates. A single finger amputated in Zone 2 often isn’t — not because it can’t be done, but because the result frequently disappoints.
The question is never “can it be reattached”. It’s “will the reattached one be better than the alternative”.
If you’re reading this in the first hours after an injury, stop here and read what to do in the first hour instead. Wrap the part, keep it cool, do not put it directly on ice, go now.
The phases
- Days 0 to 7 — survival. Ward-based. Warm room, no caffeine or nicotine (both constrict vessels and genuinely cost digits), position monitored hourly, colour and temperature checked constantly. Roughly 90% of vascular failures happen in this window.
- Week 1 to 3 — protected motion. Custom splint. Gentle controlled movement of what’s allowed, guided by which structures were repaired and the surgeon’s protocol. Oedema control starts here.
- Week 3 to 6 — the risky middle. The tendon repairs are at their weakest exactly when the hand starts feeling usable. The rules tighten rather than loosen.
- Week 6 to 12 — active range and light strength. Bone union is usually confirmed around here. Scar work begins in earnest.
- Month 3 to 12 — sensory re-education. Nerves regrow at roughly a millimetre a day. The brain has to relearn what the new signals mean, which is a training programme, not a waiting game.
- Month 12 to 24 — final picture. Secondary surgery, if needed, usually happens in this period: tenolysis for adhesions, joint releases, further nerve work.
What the result usually looks like
Cold intolerance is near-universal in the first two years, and for many people it never fully goes. In a cold climate it can be the single most limiting symptom, and nobody mentions it before surgery.
Sensation usually returns partially, and better in children than adults. Protective sensation — knowing you’re touching something hot or sharp — matters more day to day than fine discrimination.
Movement is the variable one. Expect stiffness. Expect to work for every degree.
Smoking after a replant is the fastest way to lose it. Not a lecture, just the mechanism: nicotine constricts the vessels the whole thing depends on.
The part nobody schedules
Traumatic amputation is a psychological injury as well as a physical one.
Nightmares, flashbacks to the moment, avoidance of the machine or the setting, and a quiet grief about a hand that doesn’t look like yours anymore are all common and all normal.
People push through it because the finger survived and they feel they’re not entitled to be upset. Say something to your team. It’s part of the injury, not a weakness in how you’re handling it.
Blood flow keeps a finger alive. Movement, sensation and use are what make it yours again.
If you’ve had a replant and you’re not in hand therapy yet, that’s the call to make this week. This is the single most protocol-dependent recovery in the whole of hand rehab, and it does not go well unsupervised.
Every article on this site is written using the Closing Window Method: name the window your condition runs on, find where you are in it, and act while it’s still open.