Replantation Workup

  • Author: Mark I Langdorf, MD, MHPE, FAAEM, FACEP, RDMS; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Aug 11, 2011
 

Laboratory Studies

Assess the patient's hemoglobin/hematocrit at baseline, and follow up with serial determinations if significant blood loss is suspected. Assess coagulopathy by determining the prothrombin time/international normalized ratio (INR) and platelet count if the patient's history suggests a bleeding disorder or liver disease.

Type and cross-match 2-4 units of packed red blood cells if the patient's history suggests significant blood loss.

Obtain an electrocardiogram in patients older than 45 years and in those with a history of cardiac ischemia or arrhythmia.

A case report suggests that pulse oximetry can be used to document arterial flow to a part that is incompletely amputated when clinical findings of arterial flow with Doppler ultrasonography suggest an absence of arterial perfusion.[7]

Next

Imaging Studies

Radiographs of the injured part:

  • Obtain posteroanterior, lateral, and oblique radiographs of the amputated part and stump.
  • Carefully assess for radiopaque foreign bodies.
  • Comminution of the fracture implies a crush injury mechanism and is associated with soft-tissue trauma.
  • If the joint is destroyed at the level of amputation, perform arthrodesis (fusion); this results in loss of joint function.
  • If a crush injury is severe, a mosaic of fragments may preclude attempts at replantation.

See the images below.

Radiologic appearance of a hand with two-digit ampRadiologic appearance of a hand with two-digit amputation. Radiologic appearance of a complete thumb amputatiRadiologic appearance of a complete thumb amputation.

Obtain a chest radiograph if it is indicated by the patient's age or underlying lung or heart disease or if blunt or penetrating chest injury is suspected.

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Contributor Information and Disclosures
Author

Mark I Langdorf, MD, MHPE, FAAEM, FACEP, RDMS  Professor of Clinical Emergency Medicine, Department Chair, Associate Residency Director, Department of Emergency Medicine, University of California at Irvine

Mark I Langdorf, MD, MHPE, FAAEM, FACEP, RDMS is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, Council of Emergency Medicine Residency Directors, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

J Akiva Kahn, MA  University of California, Irvine, School of Medicine

J Akiva Kahn, MA is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Student Association/Foundation, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Lacey King  University of California, Irvine School of Medicine

Lacey King is a member of the following medical societies: American Academy of Emergency Medicine and American College of Emergency Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

Assaad J Sayah, MD  Chief, Department of Emergency Medicine, Cambridge Health Alliance

Assaad J Sayah, MD is a member of the following medical societies: National Association of EMS Physicians

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Eric L Legome, MD  Chief, Department of Emergency Medicine, Kings County Hospital Center; Associate Professor, Department of Emergency Medicine, New York Medical College

Eric L Legome, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, Council of Emergency Medicine Residency Directors, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD  Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors, Ziad N Kazzi, MD, and Akiva Kahn, MD, to the development and writing of this article.

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Previous
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Complete amputation of two digits.
Radiologic appearance of a hand with two-digit amputation.
After two-digit replantation.
Complete thumb amputation.
Radiologic appearance of a complete thumb amputation.
Complete thumb amputation.
After thumb replantation.
Surgical amputation of a left big toe.
Toe-to-thumb transfer.
 
 
 
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