Replantation After Traumatic Finger Amputations Performed in Lehigh Valley

In September 2021, a 30-year-old male, after a crush injury at work, came into the emergency department at Lehigh Valley Hospital–Cedar Crest with severe damage to his small, ring and long fingers.

Nathan Miller, MD, orthopedic hand surgeon and plastic and reconstructive surgeon with Lehigh Valley Orthopedic Institute and Lehigh Valley Institute for Surgical Excellence, explains what he observed: “The fingers were amputated at the middle of the digit, only connected by the nerves. All the skin, bone, tendons, arteries and veins were completely severed.”

In the past, people requiring digital replantation would immediately be sent to larger centers in Philadelphia or New York City.

Today, with the advanced expertise of Miller, they are treated in the Lehigh Valley. Miller is fellowship-trained in hand, upper extremity and microvascular surgery.

The patient underwent a six-hour surgery to reattach his fingertips and maximize function of his fingers and hand. Miller was able to successfully reattach the ring and long fingers, restoring blood flow and stabilizing the digits. The wound to the small finger was closed.

Postoperatively, a team of clinicians cared for and monitored the man, first in the intensive care unit, to listen for blood vessel signals every hour.

“We do this to make sure there isn’t any evidence of blood clots that have formed in the blood vessel connection, which is a risk,” explains Miller, noting that a loss in blood flow typically requires additional surgical intervention.

Fortunately, this individual experienced optimal healing and was discharged from the hospital within a week. Two weeks following surgery, once the soft tissue had healed, he began a dedicated hand therapy program to “get the tendon repairs moving,” Miller says, “to make sure he could maximize as much motion as he could get out of the fingers.” 

Three months after his multifinger digital replantation, the individual was able to fully flex within the palm and extend all his fingers. He returned to work with full range of motion and no restrictions.

Miller attributes his exceptional precision to advanced training at R. Adams Cowley Shock Trauma Center at the University of Maryland in Baltimore, one of the premier trauma centers in the world.

“As part of that training, I did a lot of traumatic upper extremity reconstruction, more specifically, how to reattach fingers, hands and sometimes whole arms.

After my initial training as a plastic and reconstructive surgeon in residency, I gained additional experience in complex reconstructive microsurgery and complex hand surgery,” he says.

Miller is proud to bring the advanced surgery of digital replantation to the region. “We now have the ability to handle all aspects of upper extremity trauma and care,” he says. “People don’t have to get transferred to some other facility. They can stay right in their hometown to receive this high level of care.”