Finger amputation

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

Clinical Features
  • Partial or complete amputation of finger

Differential Diagnosis

Distal Finger (Including Nail) Injury

Hand and finger injuries

Evaluation
  • 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!)
  • X-ray limb and part
  • 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


See Also

References
  1. Lloyd MS. et al. Preoperative management of the amputated limb. Emerg Med J. Jul 2005;22(7):478-80
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