gms | German Medical Science

Objectives/Interrogation: Treatment outcomes presentation of patients with upper limb amputation injuries, whose amputated fingers were inadequately treated during transportation to the replantation center and suffered from cold injury.

Methods: A set of 21 patients (19 men, 2 women) operated at Department of Plastic and Aesthetic Surgery in Brno from 1 January 2007 to 31 December 2017. Following is an overview of malpractices used to treat the amputates: 8 times the amputate was packed in gauze with dry ice, 4 times amputates were frozen in ice cube, 3 times frozen in crushed ice, 1 hand was lined with frozen saline solution, 2 amputates were transported in package of frozen vegetables. There were cases when the amputate was first frozen by ice, then dipped in saline solution and then dried in the ambulance or another case, when the amputate was primarily heavily burned with fire, then it was cooled in the snow for 45 minutes and, then it was wrapped in gauze and brought in a snowball.

Results: Primary amputation was performed in 8 patients (reasons: 3 times - mechanical destruction of amputate, 3 times - thermal damage, 1 - a patient's wish and 1 - indication of comorbidity). Two patients were treated with the composite graft method, both grafts were successfully healed.

Replantation was performed in 11 patients and in one case the hand was completely replanted. Perioperative complications were frequent, repeated arterial thrombosis in 2 patients, necessity of micro anastomosis of both vessels, use of venous graft, 3 patients had repeated venous anastomosis for repeated venous thrombosis, 2 patients had rapid development of burn changes on replanted fingers - skin whitening, then livid color and formation of blisters. In 2 patients, the blood flow was very slow and blood supply was established with a time delay in ICU. Revision operations were performed in 6 patients, the reasons were arterial thrombosis, graft thrombosis, 3 times venous thrombosis, once bleeding, and twice finger amputation for necrosis. 11 fingers and one hand were healed on the sample of 8 patients. Thermal damage was unmasked after the replantation. Replants failure occurred in 3 fingers in 3 patients. The overall success rate of replantation of frozen fingers was 73%.

Conclusion: Even inadequately treated and thermally damaged amputates can be replanted with a relatively high success rate but more frequent perioperative and postoperative complications have to be considered.