The indications for replantation are:

  1. Amputation of a hand or arm.
  2. Amputations proximal to metacarpo-phalangeal joints
  3. Amputation of thumb
  4. Amputation of two or more fingers
  5. Amputation of single finger in a child. (note that a single finger amputation in an adult is not usually an indication for replantation.

Relative contra-indications are:

  1. Severe avulsion injuries.
  2. Severe crushing
  3. Massive contamination

Discuss all cases with the Plastic Surgeons

Care of Amputated Part

Digits for replantation should be wrapped in saline soaked gauze and placed in a clean polythene bag. This bag should be placed on crushed ice.  Do not let ice come in direct contact with the amputated part.  The aim is to cool the part not freeze it.

Care of the stump
Wrap stump in sterile saline soaked gauze and then apply a pressure dressing. Elevate

DO NOT ligate vessels except in extremis. Analgesia/tetanus prophylaxis/antibiotics as indicated.

Refer patient to the Plastic Surgeons.