Finger amputation: Difference between revisions
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==Indications for Replantation== | ==Indications for Replantation== | ||
*Thumb | |||
*Multiple digits | |||
*Amputation level between palm and distal forearm | |||
*Distal to FDS insertion | |||
*Amputations in children | |||
==Contraindications== | ==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== | ==Warm Ischemia== | ||
| Line 22: | Line 22: | ||
==Treatment== | ==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|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 (Main)|Antibiotics]]=== | ===[[Antibiotics (Main)|Antibiotics]]=== | ||
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*[[Penile amputation]] | *[[Penile amputation]] | ||
== | ==References== | ||
<references/> | <references/> | ||
[[Category:Orthopedics]] | [[Category:Orthopedics]] | ||
[[Category:Trauma]] | [[Category:Trauma]] | ||
Revision as of 18:51, 6 May 2016
Indications for Replantation
- Thumb
- Multiple digits
- Amputation level between palm and distal forearm
- Distal 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[1]
Cold Ischemia
- 24 hours for digit; 12 hours for a muscle bearing extremity[1]
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
- 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
- ↑ 1.0 1.1 Lloyd MS. et al. Preoperative management of the amputated limb. Emerg Med J. Jul 2005;22(7):478-80
- ↑ 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/