What to do in case of finger or hand amputation
Traumatic amputation is an absolute emergency. Rapid and appropriate care in a specialized SOS HAND center can allow, in some cases, reimplantation of the amputated segment and better functional recovery.
⚠️ Every minute counts: Actions taken immediately after the accident are crucial for prognosis
It is the complete or partial section of a finger, several fingers, or a larger hand segment, following trauma. Mechanisms vary: clean section by a sharp object, crushing, tearing, or even avulsion by a ring worn on the finger.
This often spectacular and impressive accident is an absolute emergency. Rapid and appropriate care in a specialized SOS HAND center can allow, in some cases, reimplantation of the amputated segment and better functional recovery.
Simple actions, performed at the accident site, can significantly improve prognosis.
Reassure the injured person and keep them calm.
Immediately remove rings and jewelry from the injured hand (rapid swelling will make this removal impossible later).
Apply a compressive dressing on the amputation stump to control bleeding.
NO TOURNIQUET: A compressive dressing is generally sufficient. A tourniquet is unnecessary and ligation of arterial axes is harmful.
Stay fasting: Do not eat, drink, or smoke, in anticipation of possible surgical intervention.
Recover the amputated fragment (finger, fingertip, hand segment).
Rinse it briefly with clean water to remove gross contamination.
Wrap it in a clean cloth or gauze.
Place everything in a clean, sealed plastic bag (freezer bag type), well closed.
Place this bag on ice or in a very cold container, never putting the fragment in direct contact with ice (direct contact damages tissues and can make reimplantation impossible).
Do not use colored disinfectant, liquid, or freezer to preserve the fragment.
Quickly direct the injured person to a SOS HAND center or call emergency services to organize the fastest possible transfer.
In Luxembourg: Go directly to Kirchberg Hospital Emergency (tel. 2468 5500). SOS HAND Luxembourg provides 24/7 care.
Well preserved (dry and cold, at about 4°C), an amputated fragment can remain viable for several hours. However, it is desirable to perform reimplantation before 4 hours of "warm" ischemia (room temperature) and 6 hours of "cold" ischemia (properly cooled fragment).
Fingers, devoid of muscle tissue, tolerate delays better than larger segments. Successes have been reported after more than 90 hours thanks to optimal preservation.
The reimplantation decision is made case by case, based on several criteria: type of trauma (clean section, crushing, tearing), amputation level, quality of the amputated fragment and its preservation, care delay, and patient's general condition (age, smoking, comorbidities).
It is always a long and meticulous intervention (2 to 6 hours or more), most often performed under regional anesthesia, by a hand surgeon specialized in microsurgery.
Stabilization with pins or screws.
Suture of tendons to restore mobility.
Suture of nerves under microscope (diameter of 1 to 2 mm at finger level) to allow sensory recovery.
Suture under microscope of at least one artery and one vein with extremely fine thread and needles (70 to 100 microns) to restore blood circulation.
Repair of skin and appendages (nail).
Survival of the reimplanted finger depends on blood circulation in the repaired small vessels. Close monitoring (sometimes hourly, including at night) is essential.
Complete smoking cessation: A single cigarette can cause arterial spasm and permanently compromise finger survival.
Keep the finger warm.
Anticoagulant treatment (sometimes by electric syringe) is administered to thin blood and limit thrombosis risk.
Monitor coloration (pink = good sign), temperature and capillary pulse of the finger. Any change (white, blue or cold finger) may indicate vascular complication requiring urgent reoperation.
Recovery of a functional finger requires several months of rehabilitation efforts:
Passive mobilization only by physiotherapist (tendons are still too fragile).
Progressive active mobilization, with gradual amplitude increase.
Returns in 3 to 6 months (nerve regrows at about 1 mm per day).
Will return later with hand use.
Rehabilitation may also include lymphatic drainage, defibrosing techniques, dynamic orthoses and sensory reeducation.
Although performed by specialized teams, complication risk exists:
Survival rate varies from 90% (clean section at finger base) to less than 50% (fingertip avulsion). It depends on accident type, fragment preservation quality and care delay.
Despite nerve sutures, sensory recovery is sometimes weak or absent.
A reimplanted finger almost always causes cold intolerance with throbbing pain in winter.
The more proximal the lesion, the greater the risk of residual stiffness despite rehabilitation.
Pseudarthrosis (lack of bone consolidation), healing difficulties, hematoma, algodystrophy.
Smoking, cannabis use, diabetes and age are factors worsening prognosis.
Sometimes, for various reasons, reimplantation is not feasible or has failed secondarily. Moreover, it is sometimes preferable not to reimplant a finger known to be stiff and painful, as it can hinder the entire hand.
In these situations, alternative solutions exist to restore hand functionality:
Any amputation, even partial, of a finger or hand segment requires urgent consultation in a SOS HAND center. Rapid care allows better functional recovery and fewer sequelae.
Emergency: 112 | Kirchberg Hospital: 2468 5500