Review Question - QID 102602

This patient is presenting after traumatic amputation of a digit. The amputated body part should be wrapped in saline-moistened sterile gauze and sealed in a sterile plastic bag.

General indications for replantation of an amputated upper extremity or digit include:

1) Amputation in children
2) "Clean" amputations of upper extremity
3) Multiple digits amputated
4) Thumb amputations

Any patient who has experienced an amputation should immediately wrap the amputated appendage in saline-soaked gauze and place it in a bag. The bag can be placed on ice; however, the amputated appendage should never directly be placed on ice as this could cause a freezing injury.

Incorrect Answers:
Answer 1: Place thumb directly into cooler of ice is incorrect as direct contact with ice could injure the appendage, as the excessive cold may damage tissues and hinder replantation.

Answer 2: Place thumb in cup of cold milk is incorrect as this would be the management of a dislodged tooth. Placing the tooth in milk or dental solution could preserve it; however, the best thing to do is irrigate the tooth (do not scrub it) and replant it immediately.

Answer 3: Wrap thumb in sterile gauze and submerge in a cup of saline is incorrect as generally you do not want the thumb to be submerged. The goal is to keep the thumb sterile, moist, and cool (to decrease metabolism).

Answer 5: There is no need to save the thumb is incorrect as more aggressive attempts at replantation are often tried in injuries involving the thumb (given how critical it is). The amputated digit/extremity should always accompany the patient to the emergency department regardless of the postulated probability of replantation.

Bullet Summary:
Transporting an amputated appendage involves wrapping it in saline-moistened and sterile gauze and placing it in a sterile bag.