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Complementary Skills Deliver Surgical Success of Replanted Hand

May 01, 2023

Hand experts at Orlando Health Jewett Orthopedic Institute take a team approach to the replantation of amputated appendages, expediting the complex care necessary for successful reattachments. With one of the busiest Level I Trauma Centers in the nation, Orlando Health receives frequent emergent replant cases.

Replanted hand 1
Injured Hand
Replanted hand 2
Immediately Postoperative

“Many surgeons may perform replantations relatively infrequently, and even more rarely a traumatic amputation of an arm, leg or hand,” says Justin W. Zumsteg, MD. “We handle a high volume of complicated hand emergencies and treat more than 500 finger amputations annually.”

He and Minh D. Nguyen, MD, recently combined their skills, replanting the severed hand of a 20-year-old male patient. Both surgeons are board-certified and fellowship-trained hand surgeons, with extensive complementary experience in orthopedic hand microsurgery, neurological and vascular reconstruction, and plastic surgery.

Initially bound for a hospital near where the industrial accident occurred, the patient was quickly redirected to Orlando Health Orlando Regional Medical Center due to the complexity of the case. Though the bony injuries were able to be stabilized with conventional intermedullary nailing , the injury required vein grafts for all artery repairs and nerve grafts for all cut nerves due to the extensive crush mechanism of the injury. The surgeons took turns leading, assisting and resting throughout the eight-hour surgery to minimize the mental and physical fatigue that can accompany a complex, multi-hour surgery. Seven months later, the patient has regained almost full function of his hand and is bench-pressing 185 pounds.

Replanted hand 3
Two Weeks Postoperative

“This case went so well because Dr. Nguyen and I worked together,” says Dr. Zumsteg. "It went faster. The decision making was smoother. And having another reliable, skilled set of hands prevented surgical fatigue, allowing us to really do our best jobs.”

Replanted hand 4
Four Weeks Postoperative

Dr. Nguyen, who has successfully replanted three hands in the past three years, agrees. The surgeon received the replant call while enroute to the airport. Like Dr. Zumsteg, he headed immediately to the hospital.

“It’s important to be able to call on our partners if we need help and to be on call for them so we can do replantations efficiently with the best outcomes for our patients,” says Dr. Nguyen.

Replantation success requires coordination beyond the technical challenge of reattachment. “Our advantage at Orlando Health is our teamwork and focus on our patient,” says Dr. Nguyen. “We have skilled surgeons, and we also have personnel used to critical care trauma and working in an expedited fashion. We have expert ICU nurses who understand our amputation protocols, and comprehensive post-operative support. This team approach is our strength.”

To refer a patient, use EpicCare link or call (321) 843-5851.

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