Medicine has come a long way since the days when bloodletting was used to cure disease and mercury was thought to be the secret to immortality. One fascinating practice with an interesting history is replantation, the reattachment of a severed body part. In the Middle Ages, it was considered impossible, as many attempts to restore amputated body parts lost during bloody battles were deemed failures . The first reported successful replantations came during the Renaissance period, where severed noses could be reattached by cleaning the wound, binding the nose in its natural position, and waiting a few days .
In the 1800s, people moved onto replanting digits. Where did the idea come from, given all the past failures? Well, science was becoming more observation based, and people had seen that branches could be grafted onto trees and flourish, even bearing fruit . William Balfour reported replanting his son’s middle, index, and long fingers in the Edinburgh Medical and Surgical Journal in 1814, and many reports of successful digit reattachments followed . Interestingly, digit replantation appeared to have been performed without intentional vascular anastomosis – without having to connect the severed blood vessels.
The 1900s was the era of replantation experimentation. Scientists performed transplantation experiments on dogs, amputating and reconnecting arteries, veins, nerves, and noting the results. Unlike digits, major limbs have much more muscle mass and rapidly restoring proper blood flow is critical to preserving the severed body part . A number of clinical advancements addressed the three major obstacles to replantation: infection, thrombosis (obstruction of blood flow by blood clots), and bone fixation . With the discovery of antibiotics such as penicillin, antithrombotics like heparin, and advances in bone realignment and splinting techniques, the stage was set.
Finally, in 1962, Ronald A. Malt, a surgeon at Massachusetts General Hospital replanted the right arm of a 12-year-old boy after an accident that resulted in an above elbow amputation. The procedure was a success, repairing two brachial veins, the axillary artery, four major nerves, and various muscles, eventually restoring much of the arm’s strength, sensation, and motor coordination . Later, microsurgical advancements improved small vessel anastomosis, further increasing replantation success. Today, when doctors are dealing with replantation situations, their dilemma is not whether replantation is possible, but whether it is the right choice.