Finger amputation

Indications for Replantation

1. Thumb
2. Multiple digits
3. Amputation level between palm and distal forearm
4. Proximal to FDS insertion
5. Amputations in children

Contraindications

1. Severely crushed or mangled parts
2. Prolonged warm ischemia time
3. Single digit
4. Severe contamination
5. Age >60, poor health, atherosclerotic disease
6. Avulsion injury
7. 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

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

Antibiotics

Cefazolin (Ancef) 2g IV

AND

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

See Also

• Fingertip Laceration
• High-Pressure Injection Injury
• Penile amputation