Finger amputation: Difference between revisions
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#X-ray limb and part | #X-ray limb and part | ||
#[[Tdap]] | #[[Tdap]] | ||
#Consult surgery | #Consult surgery | ||
##The management of distal fingertip amputation is controversial and should be individualized | ##The management of distal fingertip amputation is controversial and should be individualized | ||
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##Most amputations distal to the DIP are managed with local wound care and allowed to heal by secondary intention | ##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 | ##If bone is exposed, it may be trimmed back with a rongeur to just below the skin level | ||
===[[Antibiotics (Main)|Antibiotics]]=== | |||
{{Open Fracture Antibiotics}} | |||
==See Also== | ==See Also== | ||
Revision as of 05:19, 29 June 2014
Indications for Replantation
- Thumb
- Multiple digits
- Amputation level between palm and distal forearm
- Proximal to FDS insertion
- Amputations in children
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
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
- 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
- Tdap
- 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[1][2]
AND
Gentamicin 300 mg (1-1.7mg/kg) IV (especially if wound is dirty)
See Also
Source
DeBonis 7/09 Adapted Burbulys
- ↑ Gosselin RA, Roberts I, Gillespie WJ. Antibioticsfor preventing infection in open limb fractures. Cochrane Database Syst Rev. 2004;1:CD003764
- ↑ The NNT Review http://www.thennt.com/nnt/antibiotics-for-open-fractures/