Major trauma may result in partial or complete removal of a limb. The high kinetic injury, crush, or avulsion forces required often cause extensive damage and heavy contamination. Other significant injuries to the thorax and abdominal cavities should be considered and may be life-threatening.
Management and Disposition
Advanced trauma life support protocols should be rapidly initiated. The injury should be managed as an open fracture with appropriate antibiotics and tetanus prophylaxis. The amputated part should be kept clean, irrigated with sterile saline, wrapped in a sterile dressing, placed in a plastic bag, and put on ice. Except for minor digit amputations, patients should be admitted under trauma and orthopedic consultation for close monitoring of neurologic and vascular status.
While reimplantation is often not possible due to tissue loss and contamination, all patients should receive consideration. Young, healthy individuals with sharp, guillotine injuries without significant avulsion or crushing damage are the best candidates. Radiographs may help delineate the exact spot of injury and reveal associated dislocations or fractures.
Cooling the amputated part will increase viability from approximately 6-8 hours to 12-24 hours.
Postreimplantation limb shortening may create significant disability. Proper use of postinjury prosthetics may be the better option.
Lower Extremity Amputation. A below-the-knee amputation from a motorcycle accident. These injuries are often associated with significant, and potentially life-threatening, abdominal or thoracic trauma. (Photo contributor: Selim Suner, MD, MS.)
Lower Extremity Amputation. Amputation from a motor vehicle accident. (Photo contributor: Selim Suner, MD, MS.)
Finger Amputation. Digit avulsion and tendon rupture. (Photo contributor: Selim Suner, MD, MS.)
Table Saw Amputation. The high kinetic injury of a table saw can produce significant avulsion forces and contamination. (Photo contributor: Selim Suner, MD, MS.)