Eighty percent to 90 percent of amputated limbs can be successfully replanted (reattached after a complete amputation) or revascularized so that blood flow is restored to a severely damaged but still attached limb. The sooner a victim gets to surgery, the better the chances of a successful outcome.Types of amputations
Amputations usually involve fingers, hands and arms rather than legs and can be of a number of types.1. Guillotine. A clean-cut, complete detachment. An ax cutting off a finger or a saw severing a finger or arm are examples.
2. Crush. An extremity separates from being crushed. An example is a hand being cut in a roller machine.
3. Degloving. The skin is peeled off as you would take off a glove.First aid
If you are a first aider at the accident scene, you have someone call the emergency medical service (EMS) system. You should place the victim flat on his or her back in an attempt to prevent shock. Check the ABCs - airway open? breathing? and circulation (pulse)?
If no other severe injuries have occurred, your most important goal is to stop the bleeding. Do this by tearing off a dry piece of clothing (from the victim, bystander or yourself) and hold it on the amputated site with firm pressure. Next, elevate the limb above the heart level to reduce bleeding, swelling and pain. While elevating be sure to maintain firm pressure on the amputated site.
Attempt to gather all the amputated limb's parts, including bone fragments and skin. Even if they are not all replantable, pieces can be used in other aspects of the reconstruction.
If possible, care for the pieces by following these guidelines:
1. Wrap in a dry cloth (preferably sterile).
2. Wrap in plastic or place in plastic storage bags (something that is waterproof), and
3. Place on ice. Do not pack in ice; do not use dry ice; do not put them in direct contact with ice or water. Doing so may lead to frostbite, waterlogging and tissue breakdown.
Tourniquets are usually not needed and may cause further damage. Collect as much information as is possible for the surgeon: how the injury happened, the victim's age, allergies, date of last tetanus shot, any pertinent medical history, time of last food eaten.
Good success is experienced by those with amputations of the palm, wrist or forearm because blood vessels in those areas are larger and easier to reattach. Also, those with a clean-cut guillotine amputation with minimal avulsion or crushing have better success. Surgeons always try to save a thumb because it's essential for gripping and holding. They also try to save more than one finger if several have been severed because they can't tell which will regain the most function.
Victims with lower extremity amputations are rare candidates for replantation because the victim will be left with legs of different lengths. Such is attempted in children though because their future needs are unknown and they adapt to the replanted limbs better than adults.
Muscles without blood lose viability or reactivity within 4 to 6 hours. Fingers with tendons and ligaments can tolerate a longer amputated time period than limbs.