DIGIT AMPUTATIONS

Question 1

History

Answer 1

Time and mechanism of injury (sharp versus crush)
Patient age
hand dominance, occupation
Past medical history including vascular risk factors

Question 2

Allen Classification

Answer 2

Type 1: Pulp only
Type 2: Pulp and nail bed injury
Type 3: Pulp, nail bed injury, and distal phalanx fracture
Type 4: Pulp, nail bed injury, distal phalanx fracture, and nail loss

Question 3

Indications for replantation

Answer 3

Injuries in children
Injuried to thumb
Multiple digit
amputation
Single digit amputation proximal to the insertion of the FDS

Question 4

Goal of replantation

Answer 4

Preserve 2 sensat digits to oppose each other
Motion preferred over strength

Question 5

Strong contraindications to replantation

Answer 5

Crush
Avulsion

Question 6

Relative contraindications to replantation

Answer 6

Multiple levels of injury to the amputated part
Prolonged ischemia time (>24 hrs)
Significant co-morbidities: DM, severe pulmonary or cardiac disease
Smoking history
Injury between the MCP joint and midlevel of the middle phalanx

Question 7

Management

Answer 7

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

Question 8

Acceptable warm vs. cold ischemia times

Answer 8

Acceptable warm ischemia times
12 hours for digit; 6 hours for muscle bearing extremity
Acceptable cold ischemia times (i.e. time amputated part is on ice)

24 hours for digit; 12 hours for a muscle bearing extremity

Question 9

Indications for Rongeur

Answer 9

Any phalanx amputation with exposed bone not amenable to replantation
Distal phalanx amputation with exposed bone
Amputation through the distal interphalangeal and proximal interphalangeal joints
Amputation through the proximal or middle phalanx diaphysis

Question 10

Steps for Bone Rongeur

Answer 10

https://www.emrap.org/corependium/chapter/reclYtVkwSenmEU5y/Bone-Rongeur-for-Finger-Amputations#h.uzcy883upspy