Traumatic Amputation - Indications - Contraindications

Contraindications

• Replantation is generally indicated in the following amputations:

• 1. Multiple digits • 2. Thumb • 3. Hand amputations through the palm or carpus • 4. Wrist or forearm • 5. At or proximal to the elbow when there is a clean-cut guillotine-like amputation • 6. Individual digits distal to the insertion of the flexor digitorum superficialis on the middle phalanx • 7. Amputations in a child

• Relative contraindications to replantation are:

• 1. Amputations at multiple levels • 2. Mangled parts • 3. Psychiatric illness • 4. Patients in whom serious illness or disease coexist • 5. Individual finger amputations in zone two proximal to the FDS insertion • 6. Amputation with prolonged ischemia time • 7. Wounds with extensive soil contamination, especially from agricultural injuries • 8. Ring avulsion amputations • 9. Small (5th) Digit of Hand Dr. Garry S. Kitay, M.D. and Bruce Steinberg, M.D Hand surgeons: “Indications - Contraindications For Upper Extremity Replantation”, The Jacksonville Orthopaedic Institute, Hand Center, USA.