Traumatic finger amputation requires immediate, precise action to maximize the chance of successful reattachment, a procedure known as replantation. The viability of the severed tissue depends directly on how quickly and correctly the part is handled and preserved immediately following the injury. Understanding the proper protocol for both the injured person and the amputated digit is paramount, as errors in the initial moments can compromise the outcome of complex microsurgery. Time is a significant factor, making a rapid, informed response a priority.
First Aid for the Injured Person
The immediate focus following a traumatic amputation must be on stabilizing the patient, as life-threatening blood loss and shock are the primary concerns. Quickly call for emergency medical services (EMS) while simultaneously addressing the injury site. Control severe bleeding by applying firm, direct pressure to the stump using a clean cloth, sterile gauze, or a pressure dressing.
Maintaining continuous, steady pressure on the wound helps promote clotting and constrict damaged blood vessels. Elevating the injured hand above the heart can also slow the rate of blood flow to the area. If the initial dressing becomes soaked with blood, do not remove it, as this may dislodge forming clots; instead, apply additional layers over the top and maintain pressure.
The patient may quickly develop signs of shock, such as paleness, rapid pulse, or lightheadedness, resulting from blood loss or trauma. Keep the person lying down, calm, and covered with a blanket or jacket to maintain body temperature. Reassurance and psychological support are important while waiting for professional medical help. Do not give the injured person anything to eat or drink, as this could complicate potential emergency surgery.
Proper Preservation of the Amputated Part
The goal of preserving the amputated part is to maintain tissue viability, which is highly sensitive to temperature and dehydration. Gently rinse the severed digit with clean water or sterile saline solution for no more than ten seconds to remove visible debris or contamination, but avoid scrubbing or soaking the part. Handle the finger only by its edges, taking care not to touch the severed tissue surfaces, which contain delicate structures crucial for reattachment.
Once cleaned, the finger must be wrapped in a slightly moistened material, preferably sterile gauze dampened with saline. If sterile materials are unavailable, use a clean, non-fluffy cloth or paper towel. Ensure the material is only damp, not saturated, to prevent tissue maceration.
The wrapped finger must then be secured using the “double-bag” method to prevent direct contact with the cooling medium and maintain sterility. Place the wrapped digit into a small, sealed plastic bag or a clean, watertight container. This first layer prevents contamination and keeps the tissue from becoming waterlogged.
The second stage involves placing that sealed inner bag into a larger container holding the cooling agent. The ideal method uses a mixture of ice and water, creating a slush that provides gentle, consistent cooling around 4°C (39°F). Placing the bag on this ice-water mixture maintains a low temperature without freezing the tissue, which would cause irreversible damage. Never place the digit directly on bare ice or use dry ice.
Transporting the Patient and the Part
Transport must be executed quickly and efficiently to minimize ischemia time (the time the severed finger is without circulation). Fingers, which lack large muscle masses, can tolerate cold ischemia for a longer period—typically up to 12 to 24 hours under proper cooling. However, the best outcomes are consistently associated with the shortest possible time to reattachment. The window for warm ischemia (time at room temperature) is much shorter, ideally less than six to eight hours.
Before initiating transport, contact the receiving hospital or EMS team immediately to notify them that a traumatic amputation has occurred. This allows the medical facility to prepare the specialized surgical team, including microsurgeons, and the operating room. Alerting the hospital ensures there is no delay in assessing the replantation potential upon arrival.
The properly packaged and cooled finger must travel with the patient to ensure it is not separated during transfer. Maintain the cold chain during transport by periodically checking that the cooling container still contains ice and water slush, preventing the temperature from rising. Ensure the inner bag remains sealed and dry, and that the patient is kept warm and monitored for signs of shock throughout the journey.