HWN Suggests

The Nuts & Bolts of Finger Amputation

The following injuries should be evaluated for replantation as patients will benefit functionally: (1) injuries involving the thumb, (2) multiple fingers, (3) the hand at the level of the wrist or distal forearm, (4) the arm at the level just proximal to the elbow, (5) possibly single digit amputations in setting of prior finger amputations of the same hand, and (6) any part in a child. Next, evaluate the amputated part.

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 A Case of Finger Amputation - Emergency Medicine Blog

Zone III injuries result in the loss of bone and the partial or entire nail bed. Injuries in zone II or III may require flap coverage but most of these fingertip injuries may be treated on an outpatient basis.

 Fingertip Amputations: What YOU need to know

Digital nerve blocks are typically the best method for anesthesia; consider the wing block.

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Stop pointing fingers- Distal finger amputations

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BOLD Bones: The crushed finger

The management for an amputation of a digit, or part of a digit, is very similar with a focus on how the amputated specimen was cared for (wrapped in a bag on ice in another bag, etc) and which digit it was.

EM@3AM: Finger Amputation

General indications for replantation: Thumb, Multiple digits, Single digit distal to the insertion of the flexor digitorum superficialis tendon, Pediatric amputations.

Field Amputation

I know what you are all thinking… No, I’m not crazy. Yes, you’ll probably never do one. No, this is not a common procedure. You just might, however, be in a situation on Air Care where knowing how to correctly perform this procedure can safe a life.

Finger Amputation

The amputated part also should be covered with saline moistened gauze and placed in a water-tight sealed bag. This bag should then be placed in an ice-water slurry (50% ice and 50% water with the goal of an ideal temperature of 4°C), and the time should be documented. The amputated digit should not be placed directly into ice, dry ice, water, or saline, which can cause significant destruction of viable tissue.

Fingertip injuries

Fingertip injuries are extremely common and comprise the most common hand injuries. They are often viewed as a relatively minor injury but their improper management can lead to considerable loss of skilled hand function.

Fingertip Injury

The amputated digit should be wrapped in sterile gauze that has been moisten with normal saline. Place the digit in a sealed water tight bag, and place the digit on ICE, making sure to note time digit went on ICE.

Maximizing ED Management of Amputations

ED management is the same for ALL types of traumatic amputation => ALL patients are candidates for reimplantation until a surgeon says otherwise!

Should We Give Fingertip Amputations with Exposed Bone Prophylactic Antibiotics?

Meticulous wound care early after injury limits risk of infection above all else. Prophylactic antibiotics may have no effect on infection risk for healthy adult patients with distal fingertip amputations. However, the data on these operating room managed patients cannot be extrapolated to patients debrided in the ED.

When Snow Blowers Attack: How to Use a Rongeur in Finger Amputations

Your patient in the Emergency Department has a Zone II or Zone III finger amputation which requires primary closure of the wound prior to discharge with appropriate outpatient follow up. However, a protruding piece of bone often prevents closure of the skin flap and requires trimming by using a rongeur. While this process is typically carried out by an orthopedic or hand surgical consultant, this post aims to introduce the use of a ronguer during management of finger amputation in the Emergency Department.

Resources

StatPearls

Indications for replantation: Thumb amputation - loss of thumb represent approximately 40 to 50% loss of hand function, Multiple finger amputations, Amputations at or proximal to palm, Pediatric patients with finger amputation(s) at any level, Single finger amputation distal to the insertion of the flexor digitorum superficialis (zone I) (studies have shown that replantation distal to this insertion point had better outcomes than those proximal), Patient consideration - specialist requirement, e.g., occupation or pre-morbid compromised hand function.