Review Question - QID 102607

A 35-year-old with an amputation of his index finger with a sharp object, such as a circular saw, has a high chance of successful finger replantation with proper storage of the digit. It should be stored in a sterile plastic bag with saline moistened gauze on ice for the best prognosis.

Patients with possible amputations require emergent evaluation for both hemodynamic instability along with the vitality of tissue in both the patient and the detached limb. It is necessary to control bleeding in the patient if vessels (particularly arteries or arterioles) are still bleeding, as this may lead to rapid hemodynamic instability. In addition, the digit must be cleaned and debrided properly before surgical replantation.

Daniel et al. discuss emergent injuries of the hand and the wrist. They recommend replantation of digits that have been cleanly amputated. Conversely, crush and avulsion injuries, characteristics of contaminated amputations, and patients with significant smoking history may be relative contraindications for surgery. Additionally, Daniel et al. recommend not replanting the digit if the patient has a life-threatening medical issue, refuses to abstain from smoking three months post-surgery, or has intentionally self-amputated the digit.

Yu et al. present a meta-analysis discussing the factors for replantation outcomes. They found that gender and ischemia time had no effect on survival rate of replantation. They also found that adults with a guillotine injury (in contrast to those with crush or avulsion injuries) had a better prognosis for successful replantation. Lastly, they stated the survival rate of fingers stored in low temperature was higher than that for those stored at room temperature by almost 5-fold (odds ratio = 4.89, P=0.0002).

Incorrect Answers:
Answers 1 and 5: Transporting the distal part of the finger in a nonsterile bag increases the risk of infection of the digit and can decrease the rate of successful finger replantation.
Answer 2: Transporting the detached part of the finger in tap water may be acceptable if there is no ice, sterile water, or sterile gauze, but it is not the best choice because of the difference in osmolarity of tap water compared to saline which can damage the digit's soft tissues.
Answer 3: Transporting the detached part of the finger in a sterile bag with saline moistened gauze is adequate, but lower temperature has been associated with more successful digit replantations. Therefore, this is not the best answer.