For reimplantation surgery, the detached digit or limb is best preserved in
Replantation is not considered under the following circumstances:
a. Severe crush or multilevel injury of the amputated part
b. A psychotic patient who has willfully self-amputated the part
c. Amputation of a single digit proximal to the FDS distal insertion (zone 2), except for single-digit amputations in children or in those with demanding professions such as musicians
a. Whenever possible for a thumb amputation .
b. Single digits that have been amputated distal to the FDS insertion .
c. Multiple digits
d. Most amputations in children, including single digit amputations .
e. Guillotine-sharp clean amputations at the hand, wrist, or distal forearm
i. Ischemia time is also an important consideration when evaluating a patient for replantation.
ii. For amputated digits, more than 12 hours of warm ischemia is a relative contraindication.
iii. Promptly cooling the part to 4°C dramatically alters the ischemia factor, but even ischemia exceeding 24 hours does not necessarily preclude successful digital replantation.
iv. When primary amputation is performed, the stump is preserved with as much length as possible.
v. A short proximal phalangeal remnant at the index finger position may serve as an impediment for thumb-to–middle finger prehension, and one might consider a formal ray amputation in such a case to improve overall hand function.