INCORRECT PRESERVATION OF AMPUTATED DIGITS

  • Uroš Ahčan Klinični oddelek za plastično kirurgijo in opekline Klinični center Zaloška 7 1525 Ljubljana
  • Zoran M. Arnež Klinični oddelek za plastično kirurgijo in opekline Klinični center Zaloška 7 1525 Ljubljana
  • Eva Trpin Medicinska fakulteta Univerze v Ljubljani Korytkova 2 1000 Ljubljana
  • Kristjan Demian Sancin Medicinska fakulteta Univerze v Ljubljani Korytkova 2 1000 Ljubljana
Keywords: injury, transport, hypothermic preservation, frostbite, replantation

Abstract

Background. A decision to replant is critically dependent on the condition of the amputated digit and the way it was preserved during transport. The most common error is exposing the amputated digit to very low temperatures. Preservation directly on ice, on cooling devices in portable refrigerators, or on top of packets of frozen meat often result in a frozen and therefore unusable body digit.

Methods. An inquiry questionnaire on correct methods of preservation of amputated digits was conducted on a sample of 30 lay persons, 30 medical students, and 15 physicians.

Three simulations of most frequently used methods of preservation of amputated digit were conducted (the correct method; directly on ice; on cooling devices of portable refrigerators). Environment temperature of the (simulated) amputated digits stored was measured.

In a retrospective study, hospital records of patients treated at the Clinical department of plastic surgery and burns in Ljubljana between 1998 and 2002 were examined. We determined the number of replantations performed, gender of the patients, their age, the mechanism of the injury, the success rate of the replantation, and the duration of hospitalisation. In five case described in detail, we present an inadequate treatment of the amputated digits.

Results. The results of the questionnaire survey show that no less than 86.7% of lay person respondents would have treated the injuries in an incorrect way; same holds for 43.4% students of medicine, and 33.3% of practicing physicians.

The temperature of the simulated amputated digit remained above 5°C throughout the simulated correct treatment. When preserved directly on ice on or coolant bodies, the temperature dropped below the freezing point and never climbed above 0°C throughout the duration of the simulation (150 minutes).

Between years 1998 and 2002, Clinical department of plastic surgery and burns at the University clinical centre Ljubljana admitted 124 injured persons with completely amputated finger or fingers; the occurence was at its highest in 1998 (28 cases) and at its lowest (23) in the years 2000 and 2002 (at an average of 24.8 annually). The number of attempted replantations has been demonstrated to be on the rise (28.8% of all severed fingers replanted in 1998; and 47.9% in 2002). The success rate throughout the 5 year period was 81%. The type of injury under investigation is most frequent in population of the age group 30 to 50.

The presented cases clearly indicate that the incorrect, hypothermic treatment of the amputated extremity has a demonstrable negative effect on the result of the replantation.

Conclusions. It is obvious that the knowledge on the treatment of severed digits is lacking in both lay and professional public. The most common error in the preservation of the severed digit is dangerously low temperature during transport. Optimal conditions of hypothermic preservation are, however, difficult to maintain in the field. A more engaged education would greatly improve the conditions of transport, and increase the success rate of replantations. Adequate educational programmes; instructions to both lay persons and professionals; and devising a transport bag for hypothermic preservation of severed digits are urgently called for.


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References

Arnež ZM, Godina M, Bajec J. Oskrba in transport poškodovanca z amputiranim udom. In: Kornhauser P ed. Zbornik predavanj XX. podiplomskega tečaja iz kirurgije. Ljubljana: Kirurške službe UKC, 1984: 131–4.

Janežič T, Arnež Z. Indikacije za replantacijo. Zdrav Vestn 1998; 67: 241–4.

Pederson WC. Replantation. Plast Reconstr Surg 2001; 107: 823–41.

Soucacos PN. Indications and selection for digital amputation and replantation. J Hand Surg [Br] 2001; 26: 572–81.

Kersnik J. Problematika ocenjevanja telesnih poškodb s strani zdravnika splošne medicine. In: Balažic J, Štefanič B eds. Ocenjevanje telesnih poškodb. 2. memorialni sestanek akademika Janeza Milčinskega. Medicinsko izvedenstvo 96; 1996, dec. 3–4; Ljubljana. Ljubljana: Medicinska fakulteta, Inštitut za sodno medicino, 1996: 193–200.

Wei FC, Chang YL, Chen HC, Chuang CC. Three successful digital replantation in a patient after 84, 86 and 94 hours of cold ischemia time. Plast Reconstr Surg 1988; 82: 346–50.

Allen FM. Resistance of peripheral tissue to asphyxia at various temperatures. Surg Gynec Obstet 1938; 67: 746–51.

Sapega AA, Heppenstall RB, Sokolow DP et al. The bioenergetics of preservation of limbs before replantation. J Bone Joint Surg Am 1988; 70: 1500– 13.

Urbaniak JR. Replantation. In: Green DP ed. Operative hand surgery. 3rd ed. Vol. 1. New York: Churchill Livingstone, 1993: 1085–102.

Strohecker B, Parulski CJ. Frostbite injuries of the hand. Plast Surg Nurs 1997; 17: 212–6.

Zorec R. Motnje v uravnavanju telesne temperature. In: Ribarič S ed. Izbrana poglavja iz patološke fiziologije. 9. izd. Ljubljana: Medicinska fakulteta, Inštitut za patološko fiziologijo, 2001: 63–72.

Molnar GW, Hughes AL, Wilson O, Goldman RF. Effect of skin wetting on finger cooling and freezing. J Appl Physiol 1973; 35: 205–7.

Brunelli GA, Brunelli GR. Tissue changes at different periods of ischaemia. Int Angiol 1995; 14: 253–63.

Mowlavi A, Neumeister MW, Wilhelmi BJ, Song YH, Suchy H, Russell RC. Local hypothermia during early reperfusion protects skeletal muscle from ischaemia – reperfusion injury. Plast Reconstr Surg 2003; 111: 242–50.

Nakazato T, Ogino T. Epiphyseal destruction of children’s hands after frostbite: a report of two cases. J Hand Surg [Am] 1986; 11: 289–92.

House JH, Fidler MO. Frostbite. In: Green DP ed. Operative hand surgery. 3rd ed. Vol. 2. New York: Churchill Livingstone, 1993: 2033–41.

Van Giesen PJ, Seaber AV, Urbaniak JR. Storage of amputated parts prior to replantation — An experimental study with rabbit ears. J Hand Surg [Am] 1983; 8: 60–5.

Eder E. Najpogostejši vzroki za amputacije udov in preprečevanje teh poškodb. In: Kornhauser P ed. Zbornik predavanj XX. podiplomskega tečaja iz kirurgije. Ljubljana: Kirurške službe UKC, 1984: 145–6.

Holmberg J, Lindgren B, Jutemark R. Replantation – revascularization and primary amputation in major hand injuries – Resources spent on treatment and the indirect costs of sick leave in Sweden. J Hand Surg [Br] 1996; 21: 576–80.

Nylander G, Vilkki S, Ostrup L. The need for replantation surgery after traumatic amputations of the upper extremity – An estimate based upon the epidemiology of Sweden. J Hand Surg [Br] 1984; 9: 257–60.

Kiil J. The epidemiology of replantation cases. Scand J Plast Reconstr Surg Suppl 1982; 19: 78–80.

Chung KC, Kowalski CP, Walters MR. Finger replantation in the United States: Rates and resource use from the 1996 Healthcare Cost and Utilization Project. J Hand Surg [Am] 2000; 25: 1038–42.

Aziz W, Noojin F, Arakaki A, Kutz JE. Avulsion injuries of the thumb: survival factors and functional results of replantation. Orthopedics 1998; 21: 1113–7.

Saies AD, Urbaniak JR, Nunley JA, Taras JS, Goldner RD, Fitch RD. Results after replantaton and revascularization in the upper extremity in children. J Bone Joint Surg Am 1994; 76: 1766–76.

Romero-Zarate JL, Pastrana-Figuerua JM, Granados-Martinez R. Upper extremity replantation: three-year experience. Microsurgery 2000; 20: 202–6.

Tsai TM, Manstein C, DuBou R, Wolff TW, Kutz JE, Kleinert HE. Primary microsurgical repair of ring avulsion amputation injuries. J Hand Surg [Am] 1984; 9A: 68–72.

Goldner RD, Fitch RD, Nunley JA, Aitken MS, Urbaniak JR. Demographics and replantation. J Hand Surg [Am] 1987; 12: 961–5.

Kumar P, Hussain MT, Cordoso E, Hassanain J. Four years´ experience of limb replantation in Saudi Arabia: a clinical review. Injury 1990; 21: 161–4.

Pomerance J, Truppa K, Bilos ZJ, Vender MI, Ruder JR, Sagerman SD. Replantation and revascularization of the digits in a community microsurgical practice. J Reconstr Microsurg 1997; 13: 163–70.

How to Cite
1.
Ahčan U, Arnež ZM, Trpin E, Demian Sancin K. INCORRECT PRESERVATION OF AMPUTATED DIGITS. ZdravVestn [Internet]. 1 [cited 27May2019];73(9). Available from: https://vestnik.szd.si/index.php/ZdravVest/article/view/2350
Section
Professional Article