Finger amputation: Difference between revisions

(Created page with "==Indications for Replantation== Thumb Multiple digit Amputation level between palm and distal forearm DISTAL to FDS insertion Amputations in healthy children ==Contrai...")
 
 
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==Indications for Replantation==
==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)


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


Multiple digit
{{Hand and finger injury DDX}}


Amputation level between palm and distal forearm
==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


DISTAL to FDS insertion
===Diagnosis===
*Clinical diagnosis


Amputations in healthy children
==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==
===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


Severely crushed or mangled parts
===Discharge===
*Distal phalanx amputation with controlled bleeding


Prolonged warm ischemia time
==External Links==
 
Single digit
 
Severe contamination
 
Age >60, poor health, atherosclerotic disease
 
Avulsion injury
 
Lower extremity amputations
 
Mental instability
 
 
==Warm Ischemia==
 
 
12 hours for digit; 6 hours for muscle bearing extremity
 
 
==Cold Ischemia==
 
 
24 hours for digit; 12 hours for a muscle bearing extremity
 
 
==Treatment==
 
 
Irrigate amputated part
 
Moist, sterile gauze around amputated part, placed in water tight container in ice water
 
Xray limb and part
 
Tdap
 
Abx PPx
 
Consult surgery
 
 
==Source==
 
 
DeBonis 7/09 Adapted Burbulys
 




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


==References==
<references/>


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

Latest revision as of 14:40, 12 December 2020

Background

Wrist and hand deeper palmar dissection
  • Due to either blunt or penetrating trauma

Clinical Features

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

Distal Finger (Including Nail) Injury

Hand and finger injuries

Evaluation

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!)
  • 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[1]
  • Acceptable cold ischemia times (i.e. time amputated part is on ice)
    • 24 hours for digit; 12 hours for a muscle bearing extremity[1]

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

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
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