INCORRECT PRESERVATION OF AMPUTATED DIGITS
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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