Finger amputation - Revision history

Rossdonaldson1: /* Workup */

2020-12-12T14:40:58Z

Workup

← Older revision		Revision as of 14:40, 12 December 2020
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	===Workup===		===Workup===
	*Hand/finger x-rays		*Hand/finger x-rays
			**X-ray limb and amputated part (if available)
	*Consider pre-op labs		*Consider pre-op labs

Rossdonaldson1: /* Management */

2020-12-12T14:40:32Z

Management

← Older revision		Revision as of 14:40, 12 December 2020
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	*If amputated finger available, irrigate and wrap in moist sterile gauze		*If amputated finger available, irrigate and wrap in moist sterile gauze
	**Place in plastic bag and put bag in ice water (do not put finger directly on ice!)		**Place in plastic bag and put bag in ice water (do not put finger directly on ice!)
	*X-ray limb and part
	*[[Tdap\|Tetanus Prophylaxis]] if > 5 years since last vaccination		*[[Tdap\|Tetanus Prophylaxis]] if > 5 years since last vaccination
	*Antibiotics: Ancef 2 grams		*Antibiotics: Ancef 2 grams

Rossdonaldson1: /* Evaluation */

2020-12-12T14:40:08Z

Evaluation

← Older revision		Revision as of 14:40, 12 December 2020
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	==Evaluation==		==Evaluation==
			[[File:PMC4624359 13032 2015 28 Fig3 HTML.png\|thumb\|An X-ray image of injured hand with finger amputations.]]
			===Workup===
			*Hand/finger x-rays
			*Consider pre-op labs

			===Diagnosis===
	*Clinical diagnosis		*Clinical diagnosis

Rossdonaldson1: /* Clinical Features */

2020-12-12T14:37:29Z

Clinical Features

← Older revision		Revision as of 14:37, 12 December 2020
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	==Clinical Features==		==Clinical Features==
	*Partial or complete amputation of finger		[[File:PMC4624359 13032 2015 28 Fig11 HTML.png\|thumb\|Complete amputation at the level of the PIP joint of the right index finger without distal circulation, along with the crush fracture on the proximal phalangeal bone of middle, ring and little fingers.]]
			*Partial or complete amputation of finger(s)

	==Differential Diagnosis==		==Differential Diagnosis==

Rossdonaldson1: /* Background */

2020-04-29T20:22:14Z

Background

← Older revision		Revision as of 20:22, 29 April 2020
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	==Background==		==Background==
			[[File:Wrist and hand deeper palmar dissection.svg\|thumb\|Wrist and hand deeper palmar dissection]]
	*Due to either blunt or penetrating trauma		*Due to either blunt or penetrating trauma

Rossdonaldson1: /* Disposition */

2019-04-23T22:47:15Z

Disposition

← Older revision		Revision as of 22:47, 23 April 2019
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	==Disposition==		==Disposition==
	*Admit:		===Admit===
	**Plan for reimplantation or immediate surgery		*Plan for reimplantation or immediate surgery
	**Infection		*Infection
	*Discharge:
	**Distal phalanx amputation with controlled bleeding		===Discharge===
			*Distal phalanx amputation with controlled bleeding

	==External Links==		==External Links==

Rossdonaldson1: /* Differential Diagnosis */

2018-02-25T18:55:16Z

Differential Diagnosis

← Older revision		Revision as of 18:55, 25 February 2018
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	==Differential Diagnosis==		==Differential Diagnosis==
			{{DDX distal finger}}

	{{Hand and finger injury DDX}}		{{Hand and finger injury DDX}}

Mholtz at 05:41, 20 February 2018

2018-02-20T05:41:39Z

← Older revision		Revision as of 05:41, 20 February 2018
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	==Background==		==Background==
			*Due to either blunt or penetrating trauma

	==Clinical Features==		==Clinical Features==
			*Partial or complete amputation of finger

	==Differential Diagnosis==		==Differential Diagnosis==
			{{Hand and finger injury DDX}}

	==Evaluation==		==Evaluation==
			*Clinical diagnosis

	==Indications for ~~Re-implantation~~==		==Management==
	*Thumb		*Pain control - ([[Digital block]])
	*~~Multiple~~ digits		*If amputated finger available, irrigate and wrap in moist sterile gauze
	*Amputation level between ~~palm~~ and distal forearm		**Place in plastic bag and put bag in ice water (do not put finger directly on ice!)
	*Distal to FDS insertion		*X-ray limb and part
			*[[Tdap\|Tetanus Prophylaxis]] if > 5 years since last vaccination
			*Antibiotics: Ancef 2 grams
			*Consult hand surgery regarding possible reimplantation vs revision amputation
			**In general, amputation distal to DIP is not amenable to reimplantation
			***If bone is exposed, it may be trimmed back with a rongeur to just below the skin level
			*Acceptable warm ischemia times
			**12 hours for digit; 6 hours for muscle bearing extremity<ref name="managment">Lloyd MS. et al. Preoperative management of the amputated limb. Emerg Med J. Jul 2005;22(7):478-80</ref>
			*Acceptable cold ischemia times (i.e. time amputated part is on ice)
			**24 hours for digit; 12 hours for a muscle bearing extremity<ref name="managment"></ref>

			===Indications for Reimplantation===
			*Thumb amputation
			*Amputation of multiple digits
			*Amputation level between MCP and distal forearm
	*Amputations in children		*Amputations in children

	===~~Warm Ischemia===~~		===Contraindications to Reimplantation===
	*12 hours for digit; 6 hours for muscle bearing extremity<ref name="managment">Lloyd MS. et al. Preoperative management of the amputated limb. Emerg Med J. Jul 2005;22(7):478-80</ref>

	~~===Cold Ischemia==~~=
	*24 hours for digit; 12 hours for a muscle bearing extremity<ref name="managment"></ref>

	~~==Contraindications~~==
	*Severely crushed or mangled parts		*Severely crushed or mangled parts
	*Prolonged ~~warm~~ ischemia time		*Prolonged ischemia time
	*Single digit		*Single digit (except thumb)
	*Severe contamination		*Severe contamination
	*Age >60, poor health, atherosclerotic disease		*Age >60, poor health, atherosclerotic disease
	*Avulsion injury		*Avulsion injury
	*Lower extremity amputations

	~~==Management==~~
	*Pain control ([[Digital block]])
	*Irrigate amputated part
	*Place moist, sterile gauze around amputated part
	*Place in water-tight container in ice water
	*X-ray limb and part
	*[[Tdap\|Tetanus Prophylaxis]] if > 5 years since last vaccination
	*Consult surgery
	**The management of distal fingertip amputation is controversial and should be individualized
	**Final judgement regarding reimplantation is by surgeon
	**Most amputations distal to the DIP are managed with local wound care and allowed to heal by secondary intention
	**If bone is exposed, it may be trimmed back with a rongeur to just below the skin level

	~~===[[Antibiotics (Main)\|Antibiotics]]===~~
	~~{{Open Fracture Antibiotics}}~~

	==Disposition==		==Disposition==
			*Admit:
			**Plan for reimplantation or immediate surgery
			**Infection
			*Discharge:
			**Distal phalanx amputation with controlled bleeding

	==External Links==		==External Links==


	==See Also==		==See Also==
	*[[Fingertip ~~Laceration~~]]		*[[Fingertip laceration]]
	*[[Distal phalanx (finger) fracture]]		*[[Distal phalanx (finger) fracture]]
	*[[High-~~Pressure Injection Injury~~]]		*[[High-pressure injection injury]]

	==References==		==References==
	<references/>		<references/>

	[[Category:Orthopedics]]		[[Category:Orthopedics]]
	[[Category:Trauma]]		[[Category:Trauma]]

Rossdonaldson1: /* See Also */

2017-11-16T21:40:18Z

Rossdonaldson1: Rossdonaldson1 moved page Amputation to Finger amputation

2017-11-16T20:51:49Z

Rossdonaldson1 moved page Amputation to Finger amputation

← Older revision	Revision as of 20:51, 16 November 2017
(No difference)

← Older revision		Revision as of 21:40, 16 November 2017
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	==See Also==		==See Also==
	*[[Fingertip Laceration]]		*[[Fingertip Laceration]]
			*[[Distal phalanx (finger) fracture]]
	*[[High-Pressure Injection Injury]]		*[[High-Pressure Injection Injury]]
	*[[Penile amputation]]

	==References==		==References==