The accidental severing of a finger is a medical emergency that demands immediate action to maximize the chance of successful reattachment, a procedure known as replantation. The minutes immediately following the injury are the most important, as the viability of the severed tissue decreases rapidly without blood flow. The first step is to contact emergency medical services (911 or your local equivalent) to initiate professional care and rapid transport to a specialized facility. Acting quickly and correctly on-site to stabilize the person and preserve the digit influences the long-term functional outcome.
Controlling the Injury and Stabilizing the Patient
The immediate focus must be on the injured person and controlling blood loss from the wound site. Hemorrhage is the most serious immediate threat, and firm, direct pressure is the most effective way to address it. Apply a clean cloth, sterile gauze, or any clean dressing directly to the wound stump and press down continuously. If blood soaks through the dressing, do not remove it; simply place a new dressing on top and maintain pressure.
While maintaining pressure, elevate the injured hand above the level of the heart to help reduce bleeding and subsequent swelling. If direct pressure fails to control severe, life-threatening bleeding, a tourniquet may be applied as a last resort, placed high up on the arm. Do not apply a tight bandage or pressure around the stump itself, as this can compromise any remaining blood flow and damage tissue.
The injured person may quickly enter a state of shock, which occurs when the body does not receive enough oxygen-rich blood. Signs of shock include paleness, cold clammy skin, rapid breathing, and feeling faint or lightheaded. To manage this, help the person lie down and elevate their feet slightly, if possible, while keeping them warm with a blanket or coat.
Keep the patient as calm and still as possible, offering reassurance while awaiting emergency personnel. Do not give the injured person anything to eat or drink, which is a standard precaution before potential surgery and general anesthesia. The goal is to stabilize the person’s condition and prepare for transportation.
Proper Handling and Preservation of the Amputated Digit
Once the patient’s bleeding is controlled, attention must turn to the severed finger, as its proper preservation is directly tied to its survival for replantation. The part should be handled gently, avoiding contact with the cut surface, and should never be scrubbed or aggressively cleaned. If visible contamination is present, gently rinse the digit with clean water or sterile saline solution.
After rinsing, loosely wrap the severed part in sterile gauze or a clean, slightly dampened cloth. The wrapped digit should then be placed into a clean, sealed, watertight plastic bag or container. This bag creates a barrier between the digit and the cooling agent.
The sealed container must then be placed inside a larger container filled with an ice and water mixture for indirect cooling. This method is used to keep the tissue temperature low, slowing down the metabolic rate and extending the time the tissue remains viable, which can be up to 12 hours or more. It is crucial that the severed finger never come into direct contact with ice, as this can cause frostbite and irreversible tissue damage.
The cold ischemic time is the duration the digit is without blood supply but kept cool, and it is a major factor in determining surgical success. Optimal preservation involves maintaining a cool temperature without freezing. Do not attempt to use dry ice, and do not immerse the finger directly in any liquid without a bag barrier, as this can cause cellular damage or maceration.
The Process of Surgical Replantation and Recovery Outlook
Upon arrival at a medical center, a specialized surgical team assesses the patient and the condition of the severed digit to determine the feasibility of replantation. Factors influencing this decision include the type of injury—clean cuts have better prognoses than crush or avulsion injuries—the patient’s overall health, and the total cold ischemic time. Replantation is generally favored for the thumb, multiple digits, or any amputation in a child due to their improved healing potential.
The complex procedure is performed using microsurgery, where surgeons use specialized instruments and high-powered microscopes to reconnect minute structures. The surgery follows a precise sequence, beginning with the shortening of the bone ends to allow for tension-free soft tissue repair, which are then fixed with pins or wires. Next, the tendons and muscles are meticulously repaired.
The most technically demanding phase involves the reattachment of the arteries and veins, known as anastomosis, to restore blood flow to and from the digit. Finally, the sensory nerves are carefully aligned and repaired, a process that determines the return of feeling. The skin is then loosely closed to prevent compression of the newly repaired blood vessels.
Recovery is lengthy and requires intensive post-operative care, often involving a hospital stay of a week or more to monitor vascular health and prevent clotting with blood-thinning medication. A prolonged course of physical and occupational therapy is necessary to regain movement, strength, and dexterity. Nerve regeneration is slow, progressing at roughly one inch per month, meaning the return of sensation can take many months to over a year.
While replantation aims to restore function, regaining 60 to 80% of function is considered an excellent result. Long-term outcomes are influenced by the patient’s age, the extent of the original damage, and adherence to rehabilitation protocols, with some patients experiencing chronic issues like joint stiffness or cold intolerance.