MANUAL MINORS
Amputations of limbs, particularly the hand, are traumatic injuries resulting in the partial or complete loss of one or more fingers or the entire hand. These injuries are often caused by machinery accidents, severe trauma, or crush injuries.
Amputations require immediate management to preserve the viability of the amputated tissue and minimise complications such as loss of function or infection. The prognosis improves significantly with prompt and appropriate treatment, with the possibility of reimplantation in some cases.
Diagnosis
The diagnosis of an amputation is evident by the partial or complete loss of a part of the hand or fingers. It is essential to assess the general condition of the patient (bleeding control, signs of shock) and examine the amputation to determine whether it is clean or irregular, as this will influence the chances of reimplantation.
In addition, the vascular, nerve, and tendon structures should be evaluated to determine the extent of damage. The condition of the amputated part, as well as the time elapsed since the trauma, is critical in deciding whether reimplantation is feasible.
Differential Diagnosis
Condition | Main Clinical Characteristics | Key Differentiation |
|---|---|---|
Complete Traumatic Amputation | Total loss of a part of the limb with tissue exposure | Clear separation between segments |
Partial Traumatic Amputation | Partial connection of the limb (skin, tendons, nerves) | Amputated part still connected to the body |
Open Fracture with Avulsion | Tissue loss with visible fractured bone | Partial tissue preservation with fragmented bone |
Crush Injury without Amputation | Severe tissue damage but no complete loss | Presence of severely damaged tissue but no amputation |
Emergency Management
Initial management of an amputation begins with bleeding control, typically by direct compression or the use of a proximal tourniquet if there is massive haemorrhage. Stabilising the patient is crucial, ensuring airway, breathing, and circulation, as well as treating any signs of shock.
If the amputation is complete, the amputated part should be wrapped in a sterile gauze moistened with saline solution, placed in a sealed plastic bag, and then placed on ice. Direct contact with ice should be avoided to prevent additional damage from freezing.
Adequate analgesia should be administered, and in cases of open wounds, antibiotic prophylaxis and tetanus toxoid are indicated. Rapid evaluation by a hand surgeon is crucial to assess the viability of reimplantation.
Definitive Treatment
Definitive treatment of an amputation includes the decision of whether or not to attempt surgical reimplantation. In clean amputations, particularly of fingers, microvascular reimplantation may be attempted, involving the repair of blood vessels, tendons, and nerves.
In cases where reimplantation is not possible, surgical closure of the stumps is performed, aiming to preserve as much functionality as possible. Subsequent rehabilitation and physical therapy are essential to maximise functional recovery, and in some cases, prosthetics may be used to restore partial functionality.
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