What is an amputation? Types of injuries
- Total amputation: Total separation of a segment or limb from the rest of the body.
- Subtotal amputation: One in which there is a part connected to the body but without a vascular connection, and the cutaneous connection is less than a quarter of circumference.
- Divascularization: Total arterial or venous injury that makes the segment unviable.
- Deglobing: This is the "scouring" of a finger, hand or limb.
- Catastrophic hand or limb:
- Extremity with more than 3 fractures.
- Severe skin lesions, skin loss or avulsions.
- Multiple tendon injuries (more than three)
- Multiple nerve injuries (more than two)
- Muscle, arterial, venous, or head injuries.
- Combinations of the above.
What is a reimplantation?
Reimplantation is defined as the surgical relocation of a limb that had been separated from its corresponding body site by microsurgical repair of the blood vessels and nerves, in addition to the rest of the sectioned structures.
Causes of amputation
Amputations usually occur as a result of an accident at work (in factories, in construction, in agriculture, ...) or in traffic, and less often they are caused by other types of accidents (domestic, sports). adventure, ...)
How to act in the case of amputation
- Immediately after amputation
- What needs to be done first is to keep the patient hemodynamically stable, i.e. control the bleeding.
- Avoid bleeding by compressing the bleeding area.
- Avoid ties and tourniquets which are meant to stop the bleeding but jeopardize the vessels' preservation: they are only indicated in case of heart or respiratory failure.
- Venous pathway and hemodynamic stabilization, with plasma expanders as the patient has sometimes had severe bleeding and may be in shock and even die, despite not seeming serious at first.
- Cover the patient with a blanket to prevent heat loss.
- Wash the stump with physiological serum and cover with a semi-compressed bandage. This will usually be enough to stop the bleeding.
- Wash the amputated segment with physiological serum and wrap it with moist cloth also with physiological serum; place it in a plastic container or bag that will simultaneously fit into another container with ice and water tightly closed; this will keep it at a temperature of about 4 ° C and freeze it.
Images illustrating how to prepare the amputated segment for optimum transfer
Avoid direct contact between the amputated fragment and the ice, as freezing will make reimplantation impossible.
In the case of subtotal amputations1 avoid ice and rotation of the fragments.
1 There is some remnant of soft tissue connecting to the body, but with a complete section of the main vessels and at least 75% of the soft parts. (Complete traumatic amputation is defined as the total separation of a segment or limb from the rest of the body)
Transfer to the Hospital
- Transfer the patient to the nearest hospital as soon as possible, as it is paramount to keep the patient stable.
- To the hospital
- Preoperative (coagulation tests, ultrasound, chest X-ray, ...)
- Begin analgesia and serotherapy.
- Hemodynamic stabilization.
- Initiation of antibiotic prophylaxis with initial dose of Amoxicillin-Clavulan 2 g ev followed by 1 g / 8 h (in case of allergy: clindamycin 300 mg / 6 h ev)
Antitetanic vaccine and antitetanic toxoid (500 IU)