A traumatic amputation, such as the complete severance of a finger, requires immediate action. The first step is always to contact emergency services immediately to dispatch professional medical help. While reattaching the severed digit is important, the initial focus must be on stabilizing the injured person, as significant blood loss can quickly become fatal. Success of replantation surgery depends on the swiftness of the response and the proper handling of the patient and the severed part.
Immediate Care for the Injured Person
The primary concern following a traumatic amputation is controlling hemorrhage from the remaining stump. Immediate, firm, direct pressure must be applied to the wound using a clean cloth, sterile dressing, or any available material to staunch the blood flow. If possible, the injured limb should be elevated above the level of the heart to help reduce blood pressure at the wound site, which can slow the rate of blood loss.
If direct pressure and elevation are insufficient to control bleeding, a tourniquet may be necessary, placed above the amputation site. Modern trauma protocols recognize the life-saving potential of a properly applied tourniquet in cases of severe, uncontrolled arterial bleeding. Simultaneously, monitor the injured person for signs of shock, which may include a rapid heartbeat, shallow breathing, and pale, clammy skin.
Keep the patient as calm as possible and maintain their body temperature by covering them with a blanket or jacket. Keeping the individual warm and comfortable is a supportive measure until paramedics arrive. Never attempt to wash the remaining stump or push any tissue back into place; the goal is simply to control the bleeding and prepare for transport.
The Proper Method for Preserving the Severed Part
The common impulse to place a severed part directly on ice is incorrect and can be harmful to the tissue. Direct contact with ice or frozen gel packs can cause frostbite, damaging the delicate cells and blood vessels required for successful reattachment. This damage can make the tissue unusable for replantation surgery, which is why indirect cooling is mandatory.
The correct preservation technique involves a “double-bag” or indirect cooling method to keep the tissue cold without freezing it. First, the severed finger should be gently wrapped in a sterile gauze or clean cloth that has been moistened with saline solution or clean water. Next, place this wrapped digit into a sealed, waterproof container, such as a sterile specimen jar or a clean plastic bag.
This sealed container is then placed inside a second, larger container that holds a mixture of ice and water, creating an ice slurry. The target temperature for the digit should be around 4°C (39°F). The inner sealed bag prevents the tissue from becoming waterlogged, while the surrounding slurry provides consistent, cold temperatures without the risk of freezing.
Time Sensitivity and Viability Factors
Proper preservation is a race against the clock because severed tissue begins to die due to a lack of blood supply, a process known as ischemia. Cooling the severed digit is designed to dramatically slow down the metabolic rate of the cells, which reduces their oxygen and nutrient demands. This process effectively extends the window of time available for microsurgeons to successfully reattach the finger.
The time the digit spends at room temperature without cooling is called “warm ischemia time,” and for a finger, the maximum recommended period is typically between six to twelve hours. Once the finger is properly cooled, the “cold ischemia time” begins, extending the viability window significantly, often up to 24 hours for digits. Some reports describe successful replantation after longer cold ischemia periods, but the chances for success decrease over time.
Fingers, which contain less muscle mass than larger limbs, tolerate ischemia better. The ultimate success of the reattachment depends on prompt transport to a specialized surgical center. Correct cooling is important to maintain tissue viability and maximize the chances of restoring function, sensation, and appearance.