Amputations are a life changing injury and it is important that the initial management of the injured person is optimised. The priority for care is obviously to the injured person, and only after they have been appropriately attended too should the amputated finger/hand be retrieved and managed.
Also, many amputations are not suitable for replantation. However, the decision on whether an attempted replantation will proceed is often not made until the patient is on the operating table. Therefore, care of the amputated segment should be on the assumption that replantation is possible.
Assess the entire patient for any other injuries
Stabilise the patient as medically indicated
Contact your specialist hand surgeon early. Transport arrangements will need to be made and the receiving hospital and team “prepped” for a potentially very lengthy operation
Such a traumatic event can cause “emotional” shock. If necessary, the patient should be asked to lie down and elevate the legs
Prior to transport, a number a things need to be performed:
Place a sterile non-adherent dressing over the wound
Stop bleeding by applying direct pressure to the site of bleeding, padding and a firm bandage
Do not disturb the bandages once the bleeding has stopped
Keep the hand elevated
Provide reassurance to the injured person and maintain a calm environment
Do not delay transport. Therefore, other than the above measures, if the patient is stable all of the following should only be done if time permits. Otherwise, they will be performed at the receiving hospital.
Intravenous access
Commencement of intravenous maintenance fluid
A single dose of IV cephalosporin (1g Keflin if not allergic)
IV or IM analgesics as required
Obtain an X-ray of the hand and the amputated part
Where the digit is partially amputated, dress with a sterile non-adherent dressing – the use of jelonet and/or saline soaked combines can be used as the first dressing layer. Ensure that the partially attached digit is kept straight within the bandaging.
The hand surgeon, in conjunction with the referring party, will determine the most appropriate form of patient transport. This may involve our own private medical transport service, ambulance or hospital transport. Patients outside of the Sydney metropolitan area often require medical retrieval via helicopter. Considerations include severity of injury, time already elapsed and the first available transport service available to get the injured person to the receiving hospital safely and as soon possible.
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