Amputation/Replantation


  • To protect amputated body part:
    • Wash with sterile saline (do not scrub or use antiseptics).
    • Wrap in saline-soaked gauze and place in plastic bag and then on ice (do not place directly on ice).
  • Amputated appendages can tolerate 6-8 hours of warm ischemia and 12-24 hours of cold ischemia at 4 C.
 
Penis
  • Penis may be re-implanted up to 6 hours after amputation
Toes
  • Other than great toe, toes are not usually re-implanted
Finger
  • Fingertip amputations fit into three categories:
    • Zone I: Proximal two-thirds of nail bed intact
    • Zone II: Exposed bone
    • Zone III: Amputation of entire nail bed
  • Try to save thumb and index finger.
  • Always attempt re-implantation in children.
  • For fingertip amputations with wounds < 1 cm2, healing by secondary intention should be adequate.
  • Rongeur exposed bone and suture to provide soft-tissue coverage. Do not leave bone exposed.
 
Cooling extends the duration of viability of the amputated part.