II. Indications: Reattachment of hand, wrist or Forearm

  1. Amputated limb or finger in children
  2. Multiple fingers involved
  3. Amputated thumb
  4. Clean amputation

III. Risk factors: 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]

IV. Management: Specific amputations

V. 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

VI. Management: Patient and wound site

  1. Consult replant surgeon
  2. ABC Management
  3. Hemostasis
    1. See Finger Wound Hemostasis
  4. Intraveous fluids
  5. Tetanus prophylaxis
  6. Irrigate wound site with sterile saline
  7. If amputated limb is still partially attached
    1. Avoid unnecessary manipulation
    2. Realign limb if rotated
    3. Splint in place
  8. Wrap wound in nonadherent Vaseline Gauze
  9. Apply dry compression bandage over Vaseline Gauze
  10. Keep wound cool with insulated cold water packs
  11. Transfer to facility for possible limb reattachment

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. Daniels (2004) Am Fam Physician 69:1949-56 [PubMed]

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