II. Indications: Reattachment of hand, wrist or Forearm
- Amputated limb or finger in children
- Multiple fingers involved
- Amputated thumb
- Clean amputation
III. Risk factors: Failed limb or digit reattachment
- Amputation through proximal phalanx (esp. index, pinky)
- Tobacco Abuse (61% versus 97% for non-smokers)
- Crush wound (68% versus 91% for clean-cut wound)
- Significantly contaminated wound
- Thumb (68%) or index finger (75%) versus third-fourth fingers (83%) or fifth finger (89%)
- Dec (2006) Tech Hand Up Extrem Surg 10(3): 124-9 [PubMed]
IV. Management: Specific amputations
V. Management: Amputated Part Care
- Assign staff to be responsible for amputated part
- Gently clean limb
- Remove external debris
- Irrigate wound surface with sterile Isotonic Saline
- Do not submerge amputated part in liquid
- Wrap part in nonadherent Vaseline Gauze
- Dampen gauze with sterile Isotonic Saline
- Place amputated limb in closed sterile container
- Place container in ice water
- Do not discard any tissue until surgeon consulted
VI. Management: Patient and wound site
- Consult replant surgeon
- ABC Management
- Hemostasis
- Intraveous fluids
- Tetanus Prophylaxis
- Irrigate wound site with sterile saline
- If amputated limb is still partially attached
- Avoid unnecessary manipulation
- Realign limb if rotated
- Splint in place
- Wrap wound in nonadherent Vaseline Gauze
- Apply dry compression bandage over Vaseline Gauze
- Keep wound cool with insulated cold water packs
- Transfer to facility for possible limb reattachment
VII. References
- Antosia in Marx (2002) Rosens Emergency Med, p. 493-534
- Hori (2015) Crit Dec Emerg Med 29(3): 2-7
- Daniels (2004) Am Fam Physician 69:1949-56 [PubMed]