Amputation

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Indications for Replantation

  • Thumb
  • Multiple digits
  • Amputation level between palm and distal forearm
  • Distal to FDS insertion
  • Amputations in children

Warm Ischemia

  • 12 hours for digit; 6 hours for muscle bearing extremity[1]

Cold Ischemia

  • 24 hours for digit; 12 hours for a muscle bearing extremity[1]

Contraindications

  • Severely crushed or mangled parts
  • Prolonged warm ischemia time
  • Single digit
  • Severe contamination
  • Age >60, poor health, atherosclerotic disease
  • Avulsion injury
  • Lower extremity amputations

Management

  • Pain control (digital block)
  • Irrigate amputated part
  • Place moist, sterile gauze around amputated part
  • Place in water tight container in ice water
  • X-ray limb and part
  • Tetanus Prophylaxis if > 5 years since last vaccination
  • Consult surgery
    • The management of distal fingertip amputation is controversial and should be individualized
    • Final judgement regarding reimplantation is by surgeon
    • Most amputations distal to the DIP are managed with local wound care and allowed to heal by secondary intention
    • If bone is exposed, it may be trimmed back with a rongeur to just below the skin level

Antibiotics

Cefazolin (Ancef) 2g IV[2][3]

AND

Gentamicin 300 mg (1-1.7mg/kg) IV (especially if wound is dirty)

See Also

References

  1. 1.0 1.1 Lloyd MS. et al. Preoperative management of the amputated limb. Emerg Med J. Jul 2005;22(7):478-80
  2. Gosselin RA, Roberts I, Gillespie WJ. Antibioticsfor preventing infection in open limb fractures. Cochrane Database Syst Rev. 2004;1:CD003764
  3. The NNT Review http://www.thennt.com/nnt/antibiotics-for-open-fractures/