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