Cuts, Amputations and Replant Surgery
With heavy rains after a long summer our farmer friends are back to work. Sickles and spades in hand digging sowing chopping around from dawn to dusk. This is the time when we come across many agricultural accidents. Many patients come with injuries to hands and feet. These injuries are majority of the times treatable but due to ignorance and delay in start of treatment patients end up with loss of part or entire hand or feet, end up crippled disabled. In such injuries time is of paramount importance.
The injuries may range from simple skin cut wounds to complete amputation of part or whole of hand or foot. What can be done in such circumstances? Can these hands be saved? The answer is yes, but there should be as little delay as possible.
What should we do when there is an injury?
First, do not panic.
Second, Quickly wash the hand under running water.
Third, apply pressure on the wound and wound edges.
Fourth, is elevate the limb. Raise the hand above the head or if it's leg then make the patient lie down and raise the leg. This simple manoeuvre will stop the bleeding in 5 min. Make sure not to release the pressure before 5-10 min.
Do not tie anything proximal to the cut injury that may cause pooling of blood and increase in bleeding. Patient should be shifted to closest possible trauma centre or centre with facility for reconstruction like Ananta Plastic Surgery Center, Dabholkar corner, Kolhapur
If a part of hand or foot is completely amputated can it be replanted? Will it be functional ? The answer is yes. By using microsurgery techniques it is possible replant the amputated part back in its place. The replanted hand can regain upto 80% if it’s previous functions. In such cases time is of utmost importance. The golden period is of “6 hours”. If circulation is re established within 6 hours the part will regain nearly all of its functions. When we encounter such a case what should be done? As mentioned above, firstly the amputation stump bleeding should be stopped by applying pressure and raising the limb. Secondly the amputated part should be washed under running water or normal saline, then wrapped in a wet cloth soaked in NS and placed in a plastic bag. This bag in turn should be kept in a bag full of ice. Both should be transported to centre with microsurgical facility like Ananta Plastic Surgery Clinic at the earliest.There is a golden period of 6 hours within which if the limb is revascularised it can regain significant amount of its functions. With delay of every hour the return of functionality comes down.
What is the maximum time in which one can replant a particular part is Case of delay? Amputation at the level of fingers can be replanted in upto 12 hours. At wrist level we can tolerate upto 8 hours but for proximal level less than 6 hours is essential as with every passing hour there is increased accumulation of anaerobic metabolite in amputated parts. When revascularisation is done late these toxins can enter circulation and create toxaemia. Another method we can prolong the time is by reducing warm ischemia time . This is done keeping the amputated part cold by the method mentioned above. Direct contact with ice has to be avoided at all times, as it damages the tissue by crystallisation.
Take home message:
To stop bleeding put pressure on the wound for 5-10 mins and elevation of limb.
Golden period for replant Surgery is 6 hours.
Amputated part should be kept cold but not in direct contact with ice.