For EMS Personnel

Hand/Limb Microvascular Replantation: Preservation of the Amputated Part

When you respond to a report of a complete or partial amputation, what you do in the field can have a tremendous impact on the patient's outcome.

Our orthopedic team has developed a free poster, Hand/Limb Microvascular Replantation: Preservation of the Amputated Part, and a list of tips to help you care for your patients out in the field and increase the likelihood of successful replantation.

Do

1. Wash part(s) thoroughly in isotonic solution, preferably Ringer’s Lactate
2. Wrap part(s) in sterile gauze moistened with normal saline
3. Place part(s) in watertight sterile container
4. Place the sterile container into a second container filled with water and crushed ice

Do Not

1. Do not freeze the part(s) by placing it directly on ice or by adding any other coolant such as dry ice
2. Do not immerse the part(s) in a bag of solution
3. Do not use any antiseptics or other solutions

Patient Care

1. Resuscitate patients with intravenous fluids
2. Administer antibiotics and tetanus prophylaxis
3. Clean stump with normal saline and apply dressings to control hemorrhage. Apply compression dressings and consider tourniquets in uncontrolled arterial bleedings. Avoid clamping or ligating stump-sided vessels
4. Splint limbs with incomplete transections
5. Obtain x-rays of the amputate and the stump and send with patient
6. Arrange for appropriate method of transport in consultation with the replant surgeon

Time is of the Essence

A significant delay in reattaching the amputated part can preclude successful replantation. The more proximal the amputation, the more critical the ischemia time because of the larger muscle mass involved. Cooling is essential to maintain amputate viability.

Patient Selection

Patients with finger, extremity, scalp, ear or nose amputations may be replantation candidates. Several other factors, such as age, co-morbidities, area and mechanism of injury, are also evaluated when determining eligibility for replantation. The final decision regarding replantation can only be made by the replantation surgeon.