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Amputation
From WikEM
Contents
Background
Clinical Features
Differential Diagnosis
Evaluation
Indications for Re-implantation
- Thumb
- Multiple digits
- Amputation level between palm and distal forearm
- Distal to FDS insertion
- Amputations in children
Warm Ischemia
- 12 hours for digit; 6 hours for muscle bearing extremity[1]
Cold Ischemia
- 24 hours for digit; 12 hours for a muscle bearing extremity[1]
Contraindications
- Severely crushed or mangled parts
- Prolonged warm ischemia time
- Single digit
- Severe contamination
- Age >60, poor health, atherosclerotic disease
- 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
- 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
Cefazolin (Ancef) 2g IV[2][3]
AND
Gentamicin 300 mg (1-1.7mg/kg) IV (especially if wound is dirty)
Disposition
External Links
See Also
References
- ↑ 1.0 1.1 Lloyd MS. et al. Preoperative management of the amputated limb. Emerg Med J. Jul 2005;22(7):478-80
- ↑ Gosselin RA, Roberts I, Gillespie WJ. Antibioticsfor preventing infection in open limb fractures. Cochrane Database Syst Rev. 2004;1:CD003764
- ↑ The NNT Review http://www.thennt.com/nnt/antibiotics-for-open-fractures/
