Q: I am a 22 years old female. I have lost half of my two fingers. Is it possible to get them replaced or replanted?

A:Amputation of fingers is a difficult problem to manage. In acute amputation, we can replant the fingers provided the patient reaches a definitive centre with facility for microvascular surgery within six hours of injury. Once amputation has occurred and the wounds are healed very little can be done. However, depending on the finger lost, some reconstruction can be done by transplanting the second toe of the foot to provide a substitute function. However, this is never done for cosmetic purposes but always done for functional improvement of a major loss of a finger like thumb or index finger. A lot of poor people do not like this procedure because cosmetically does not look as good and the foot looses a toe and there is a small risk of failure of this surgery. You have not mentioned which finger is amputated and whether it is right or left hand and whether you are right handed or left handed. All these are important in decision-making and management of cases like yours. Occasionally, in some cases lengthening of the stump can be done but this does not improve the function nor does it provide you the nails for cosmesis. Prosthetic replacement seems attractive initially and can be made for use when the patient has to attend some special functions. These are purely cosmetic and most patients after enthusiastically procuring them discard these as cumbersome attachments. The media has highlighted transplant from donors in a case with loss of both the arms from a brain dead patient. This seems exciting however most people do not understand the implication of this procedure. This is because the transplanted hand/finger from the other human being will be viewed as a foreign body and the body will slowly reject the part. To prevent this, the patient has to be on a long term expensive medication called immuno-suppressants. These drugs reduce your immunity to all kinds of infections and you become vulnerable. Therefore, this procedure is not recommended except perhaps in very special situations.