An accidental finger amputation is a traumatic event requiring immediate action to ensure the injured person’s safety and the viability of the severed tissue. Rapid response and proper technique are necessary for successful reattachment until professional medical help arrives. The goal is to quickly control blood loss and correctly preserve the amputated part while transporting the individual to a hospital specializing in hand surgery. Call 911 or local emergency services immediately to mobilize professional medical assistance.
Prioritizing the Injured Person and Controlling Bleeding
After calling for help, the immediate priority is the injured person’s well-being, focusing on managing shock and controlling hemorrhage from the remaining stump. Instruct the person to lie down and provide reassurance to help keep them calm, mitigating the effects of trauma or blood loss. If signs of shock appear, such as pale skin or rapid breathing, elevate the person’s feet and use a blanket or coat to maintain body temperature.
Hemorrhage control requires the application of continuous, direct pressure to the wound site. Place a clean cloth, sterile gauze, or non-fluffy dressing directly over the bleeding area. Apply firm and steady pressure for several minutes without interruption to encourage clotting. If blood soaks through, place a new dressing directly on top; never remove the original dressing, as this can dislodge forming clots and restart bleeding.
Elevating the injured hand above the heart utilizes gravity to help reduce blood flow and slow bleeding. While maintaining pressure and elevation, inspect the wound for any objects that are easy to remove. Debris deeply embedded in the wound should be left untouched. If severe, life-threatening bleeding cannot be controlled by direct pressure, a tourniquet may be used as a last resort, but this is rarely needed for finger injuries. The focus remains on stabilizing the person until emergency medical services can take over.
Proper Care and Transport of the Amputated Part
Once the injured person is stable and bleeding is managed, prepare the severed finger for transport, as proper preservation impacts the success of replantation surgery. Gently rinse the amputated part with clean water or a sterile saline solution for a few seconds to remove obvious dirt or debris. Do not scrub the tissue or submerge it in plain water for an extended period, as this can damage the delicate cells needed for reattachment.
Wrap the severed finger in a slightly moistened, sterile gauze or a clean, non-fluffy cloth. The moisture prevents the tissue from drying out during transport, maintaining cellular integrity. Place the wrapped finger inside a clean, sealed, waterproof plastic bag to protect it from contamination.
Place the sealed bag into a second container, such as a cooler or cup, holding ice water. This double-bag method provides the necessary hypothermia, slowing the tissue’s metabolic rate and delaying cell death. Maintain the temperature around 4 degrees Celsius; direct contact with ice must be avoided, as freezing causes irreversible damage and renders the part unusable for replantation. The preserved part must travel with the injured person to ensure it arrives at the hospital at the same time for immediate assessment.
What Happens Upon Arrival at the Emergency Room
Upon arrival at the emergency room, medical personnel immediately stabilize the patient and assess the severity of the injury. The first steps involve thoroughly cleaning the wound and initiating infection prevention protocols. This typically includes administering a tetanus shot if the person is not up-to-date on their vaccinations and starting broad-spectrum antibiotics, such as Cefazolin, to minimize bacterial infection risk.
A surgical team, often including a microsurgeon, will examine the severed finger and the remaining stump to determine the feasibility of replantation. Factors influencing this decision include the mechanism of injury—clean cuts have a better prognosis than crush or avulsion injuries—and the “ischemia time,” the duration the tissue has been without a blood supply. Fingers can remain viable for up to 24 hours if properly cooled, though the chances of success decrease significantly over time.
If replantation is deemed possible, the person is prepared for microsurgery. This complex procedure involves the meticulous reattachment of structures under a high-powered microscope.
- Bone
- Tendons
- Nerves
- Arteries
- Veins
The goal is to re-establish blood flow and restore as much function and sensation as possible. Following surgery, the patient requires extensive physical and occupational therapy and vascular monitoring to prevent complications and ensure the survival of the reattached digit.