Traumatic Limb Amputation

Aka: Traumatic Limb Amputation, Traumatic Amputation, Limb Amputation, Finger Amputation, Extremity Amputation, Digit Amputation, Amputated Part Care

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II. Epidemiology

  1. Incidence: Up to 2.5% of Trauma admissions in the U.S.
  2. Lower Limb Amputation is more common than upper (3:1 ratio)

III. Management: Patient and Wound Site

  1. Consult Trauma surgery
  2. Early Hemorrhage Control is critical
    1. See Hemorrhage Management
    2. See Massive Blood Transfusion
    3. Primary focus after airway stabilization (if needed), and Hypoxia management
  3. ABC Management
    1. Caution with Endotracheal Intubation in Hypovolemia (risk of cardiovascular collapse)
      1. High initial sympathetic drive and Vasoconstriction dissipates with Rapid Sequence Intubation
      2. Delay definitive airway management if possible until adequate hemodynamic stability
      3. Have push-dose pressors available for post-intubation Hypotension
  4. Trauma Evaluation
    1. Evaluate for multisystem Trauma
  5. Prophylactic intravenous Antibiotics in significant amputations (proximal to digits)
    1. Initiate within 1 hour of hospital arrival to reduce risk of deep space infections
    2. First Generation Cephalosporins of Clindamycin
    3. Add Gram Negative coverage for more significant, multisystem injuries
    4. Add anaerobic coverage (e.g. Metronidazole, Clindamycin) for highly contaminated wounds, vascular injury
    5. Appelbaum (2024) Trauma Surg Acute Care Open 9(1):e001304 +PMID: 38835634 [PubMed]
  6. Other medications
    1. Analgesics (e.g. Ketamine, Fentanyl if hemodynamic instability)
    2. Intraveous fluids
    3. Tetanus Prophylaxis
  7. Irrigate wound site with copious amounts of sterile saline (or if unavailable, clean tap water)
    1. Local infections complicate >50% of life threatening extremity wounds requiring Tourniquet placement
    2. Rittblat (2024) Acad Emerg Med +PMID: 39686666 [PubMed]
  8. If amputated limb is still partially attached
    1. Avoid unnecessary manipulation
    2. Realign limb if rotated
    3. Splint in place
  9. Non-life threatening wounds (e.g. digits)
    1. See Fingertip Amputation
    2. See Finger Wound Hemostasis
  10. Wound Dressing
    1. Wrap wound in nonadherent Vaseline Gauze
    2. Apply dry compression bandage over Vaseline Gauze
    3. Keep wound cool with insulated cold water packs

IV. Management: Amputated Part Care

  1. Assign staff to be responsible for amputated part
  2. Gently clean limb
    1. Remove external debris
    2. Irrigate wound surface with sterile Isotonic Saline
    3. Do not submerge amputated part in liquid
  3. Wrap part in nonadherent Vaseline Gauze
    1. Dampen gauze with sterile Isotonic Saline
  4. Place amputated limb in closed sterile container
  5. Place container in ice water
  6. Do not discard any tissue until surgeon consulted

V. Management: Threatened Limb Evaluation and Reimplantation

  1. Consult reimplant surgeons
  2. Transfer to facility for possible limb reattachment
  3. Warm ischemia window of repair: 4-6 hours
  4. Evaluate limb viability (is limb salvageable)
    1. Tissue integrity
    2. Limb perfusion (pulses or handheld doppler)
    3. Neurologic function (motor and sensory)
  5. Hard signs of limb vascular injury (urgent surgical intervention)
    1. Absent distal pulses (and loss of doppler pulses)
    2. Expanding Hematoma
    3. Palpable thrill
    4. Audible bruit
    5. Pulsatile bleeding
  6. Indications for Reattachment of hand, wrist or Forearm
    1. Amputated limb or finger in children
    2. Multiple fingers involved
    3. Amputated thumb
    4. Clean amputation
  7. Risk factors for failed limb or digit reattachment
    1. Amputation through proximal phalanx (esp. index, pinky)
    2. Tobacco Abuse (61% versus 97% for non-smokers)
    3. Crush wound (68% versus 91% for clean-cut wound)
    4. Significantly contaminated wound
    5. Thumb (68%) or index finger (75%) versus third-fourth fingers (83%) or fifth finger (89%)
    6. Dec (2006) Tech Hand Up Extrem Surg 10(3): 124-9 [PubMed]

VI. Prognosis

  1. Unilateral lower Limb Amputation is associated with significant morbidity
    1. Longterm reduced mobility and independence
    2. High risk for medical and psychiatric complications

VII. References

  1. Antosia in Marx (2002) Rosens Emergency Med, p. 493-534
  2. Hori (2015) Crit Dec Emerg Med 29(3): 2-7
  3. Nutter (2026) Crit Dec Emerg Med 40(1): 22-3
  4. Daniels (2004) Am Fam Physician 69:1949-56 [PubMed]

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