BACKGROUND: Following traumatic amputation, preservation of the amputated part plays a crucial role in its viability for replantation. Proper preservation consists of wrapping the part in saline-soaked gauze inside a watertight bag and placing it on ice. Frequently, the amputated part is not preserved according to this protocol, diminishing its viability for replantation. The objective of this study is to examine the rate of proper preservation in patients arriving from home and as transfers from referring medical centers.
METHODS: A retrospective review of adult and pediatric patients at a single academic medical institution was conducted using ICD10 codes over the study period of 2015–2019. Patients were included if they suffered an acute traumatic amputation of a digit or an extremity, their amputated part was present for evaluation by the hand surgery team, and their medical record contained documentation regarding modality of preservation. Patients with partial amputations, nontraumatic amputations, and absence of amputated parts were excluded from the study. Additional data including method of patient transport, replantation attempt, and operative outcome were included. Patients were stratified based on whether or not proper preservation was employed and compared using chi-square tests.
RESULTS: A total of 91 patients met inclusion criteria. Thirty-one of these patients (34.1%) had amputated parts which were properly preserved in saline-soaked gauze in a bag on ice. Transfer patients from referring hospitals were more likely to present with properly preserved parts (45.0%) than those presenting from home (25.5%), though this did not meet significance (P = 0.051). In total, 74 patients arrived via emergency medical services with 26 (35.1%) of those patients having properly preserved parts. Of the 31 patients who had properly preserved parts, 58.1% underwent attempted replant; of the 60 patients who had improperly preserved parts, 23.3% underwent attempted replantation (P = 0.001).
CONCLUSION: The majority of patients who suffer traumatic amputations do not present with properly preserved amputated parts, making it difficult for surgeons to offer replantation. Neither interhospital transfer nor emergency medical services transport is predictive of adherence to protocol. With a direct correlation to attempted replantation, proper preservation is a crucial aspect of care. Dissemination of awareness and education to referring facilities may improve outcomes for patients who experience a traumatic amputation of an extremity or digit.