Journal Article

Proper preservation of amputated parts: A multi-level shortcoming

Massand, Sameer, Ingraham, John, Sinatro, Haley

2022

Overview

Successful replantation relies on proper preservation of traumatically amputated parts. The established protocol for preservation, however, is inconsistently adhered to. The objective of this study is to examine the rate of proper preservation in multiple patient populations. A retrospective review of patients from 2015 to 2019 at a single academic institution was conducted. Patients were included if they suffered a traumatic amputation, the amputated part was present for evaluation by the hand surgery team, and modality of preservation was documented. Additional data including method of patient transport, replantation attempt, and operative outcome were assessed. Patients were stratified based on whether proper preservation was employed and compared using chi-square tests. Ninety-one patients were included, thirty-one (34.1%) of whom had amputated parts which were properly preserved. Patients from referring facilities 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 = .051). In total, 74 patients arrived via EMS with 35.1% adherence to preservation protocol. 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 = .001). The majority of patients who suffer traumatic amputations do not present with properly preserved amputated parts, limiting potential replantation. With a direct correlation to attempted replantation, proper preservation is a crucial aspect of care and should not be overlooked when seeking to optimize efforts and results. Level IV. •Majority of patients present with amputated parts improperly preserved.•Patients via private vehicle or via EMS have similar adherence to ATLS protocol.•Education opportunities exist for ED and EMS personnel to improve patient outcomes.

• Publisher: Elsevier Inc,Elsevier Limited
• Subject: Amputation / Amputation, Traumatic - therapy / ATLS protocol / Documentation / Emergency / Emergency medical care / Emergency Medical Services - standards / EMS education / Female / Hand Injuries - therapy / Hand surgery / Humans / Improper preservation / Injuries / Male / Patients / Prehospital medicine / Preservation / Replantation - standards / Retrospective Studies / Surgeons / Surgery / Traumatic amputations