Case 56 Traumatic Amputation

W. Kelsey Snapp and Adnan Prsic

Case 56 Traumatic Amputation

Case 56 A 67-year-old male with right hand dominance sustained a sharp amputation of the distal phalanx of his left thumb with an axe 1 hour ago. The amputated segment has been brought on ice.

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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Jul 17, 2021 | Posted by in General Surgery | Comments Off on Case 56 Traumatic Amputation
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