Traumatic amputation is the loss of a body part, usually a finger, toe, arm, or leg, that occurs as the result of an accident or injury. If an accident or trauma results in complete amputation (the body part is totally severed), the part sometimes can be reattached, often when proper care is taken of the severed part and stump.

Complications can occur when a body part is amputated. The most important of these are bleeding, shock, and infection. Long-term outcome for an amputee depends on early emergency and critical care management. A well-fitting and functional prosthesis can speed rehabilitation.

Causes
Traumatic amputations usually result from factory, farm, power tool accidents, or from motor vehicle accidents. Natural disasters, war, and terrorist attacks can also cause traumatic amputations.

Symptoms
Symptoms may include:

  • Bleeding (may be minimal or severe, depending on the location and nature of the injury)
  • Pain (the degree of pain is not always related to the severity of the injury or the amount of bleeding)
  • Crushed body tissue (badly mangled, but still partially attached by muscle, bone, tendon, or skin)

First Aid

  1. Check the person’s airway. Check breathing & circulation
  2. Try to calm & reassure the person as much as possible
  3. Control bleeding by applying pressure to the wound
  4. Save any severed body parts
  5. Wrap the severed part in a clean damp cloth, place it in a sealed plastic bag and place the bag in an ice water bath
  6. DO NOT put the severed body part directly in water without using a plastic bag
  7. DO NOT put the severed body part directly on ice
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  8. Keep the person warm. Take measures to prevent shock. Lay the injured person flat and raise the feet about 30 centimetres and cover the person with a blanket or a coat
  9. Once bleeding is under control, check for other signs of injury that require emergency treatment
  10. Stay with the injured person until medical help arrives
  11. DO NOT forget that saving a person’s life is more important than saving a body part.

Steps of microsurgical management:

Inspection of both parts of the amputated limb. Evaluation of the severity and degree of damage. Decision whether replantation is possible.


If replantation is possible, bone stabilisation is performed as a first step.

Usually 2 Kirschner wire are enough.

Osteosynthesis with mini plates and screws is more stable but it needs ore time.

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Next step is tendon suturing.

Only after that comes anastomosis of the one or even better both arteries and suturing of both nerves.

Digital arteries and nerves should be managed under surgical microscope magnification.

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Next step is vein anastomosis, only after reconstruction of the artery.

When anastomosis of arteries and veins is satisfactory, we move to skin closure. Usually by using a z-plasty or even a skin graft, depending on the severity of injury.

A palmar or double (palmar and dorsal) splint is used to mobilise and protect.