Case 56 Traumatic Amputation
56.1 Description
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Sharp amputation of distal phalanx through interphalangeal joint of the left thumb
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Falls within T1 zone of flexor tendon
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No other visible soft tissue deficits or segmental injury
56.2 Work-Up
56.2.1 History
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Age, gender, and social history
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Particular attention to handedness, occupation, smoking/nicotine use, and substance abuse
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Medical history, surgical history, and comorbidities
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Mechanism of injury
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Trauma type: Sharp, avulsion, crush, ballistic, or animal and human bites
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Associated injuries, underlying fractures, dislocations, and neurovascular insult
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Time since injury and time period of ischemia of amputated segment
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Handling of amputated segment
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Should be wrapped in moist gauze, placed in a plastic bag, and then placed over ice
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56.2.2 Physical Examination
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Advanced Trauma Life Support (ATLS) protocol: ABCDs
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Complete upper extremity examination evaluating the shoulder, elbow, and hand
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Be aware of distracting injuries
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Number of digits involved
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Location of the injury
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Zone 2 flexor tendon injuries adversely affect outcome and may impact the operative plan
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Size of soft tissue deficit, if present
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Examine the amputated segment for segmental injury
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Assess perfusion and sensibility of all digits of the injured hand
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Specific deficits: Tendon, nerve, muscles, skin, and bone
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Wound bed status: Vascularity, exposed structures, nonviable skin, and contamination
56.2.3 Pertinent Imaging or Diagnostic Studies
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Standard three-view X-rays of the hand and amputated parts
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A complete set of labs prior to the operation
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Complete blood count (CBC), basic metabolic panel (BMP), and coagulation factors (prothrombin time [PT]/partial thromboplastin time [PTT]/international normalized ratio [INR])
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Type and cross for 2 units as pre-hospital blood loss can be profound
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