View source for Finger amputation

==Background==
[[File:Wrist and hand deeper palmar dissection.svg|thumb|Wrist and hand deeper palmar dissection]]
*Due to either blunt or penetrating trauma

==Clinical Features==
[[File:PMC4624359 13032 2015 28 Fig11 HTML.png|thumb|Complete amputation at the level of the PIP joint of the right index finger without distal circulation, along with the crush fracture on the proximal phalangeal bone of middle, ring and little fingers.]]
*Partial or complete amputation of finger(s)

==Differential Diagnosis==
{{DDX distal finger}}

{{Hand and finger injury DDX}}

==Evaluation==
[[File:PMC4624359 13032 2015 28 Fig3 HTML.png|thumb|An X-ray image of injured hand with finger amputations.]]
===Workup===
*Hand/finger x-rays
**X-ray limb and amputated part (if available)
*Consider pre-op labs

===Diagnosis===
*Clinical diagnosis

==Management==
*Pain control - ([[Digital block]])
*If amputated finger available, irrigate and wrap in moist sterile gauze
**Place in plastic bag and put bag in ice water (do not put finger directly on ice!)
*[[Tdap|Tetanus Prophylaxis]] if > 5 years since last vaccination
*Antibiotics: Ancef 2 grams 
*Consult hand surgery regarding possible reimplantation vs revision amputation
**In general, amputation distal to DIP is not amenable to reimplantation
***If bone is exposed, it may be trimmed back with a rongeur to just below the skin level
*Acceptable warm ischemia times
**12 hours for digit; 6 hours for muscle bearing extremity<ref name="managment">Lloyd MS. et al.  Preoperative management of the amputated limb. Emerg Med J. Jul 2005;22(7):478-80</ref>
*Acceptable cold ischemia times (i.e. time amputated part is on ice)
**24 hours for digit; 12 hours for a muscle bearing extremity<ref name="managment"></ref>

===Indications for Reimplantation===
*Thumb amputation
*Amputation of multiple digits
*Amputation level between MCP and distal forearm
*Amputations in children

===Contraindications to Reimplantation===
*Severely crushed or mangled parts
*Prolonged ischemia time
*Single digit (except thumb)
*Severe contamination
*Age >60, poor health, atherosclerotic disease
*Avulsion injury

==Disposition==
===Admit===
*Plan for reimplantation or immediate surgery
*Infection

===Discharge===
*Distal phalanx amputation with controlled bleeding

==External Links==


==See Also==
*[[Fingertip laceration]]
*[[Distal phalanx (finger) fracture]]
*[[High-pressure injection injury]]

==References==
<references/>

[[Category:Orthopedics]]
[[Category:Trauma]]