Cold Injury of Amputated Digits

Cooling of amputated parts during transportation delays the onset of ischaemic tissue damage and contributes to successful replantation. The most common error in preservation of amputated parts is exposing them to temperatures, which may cause cold injury, and thus render them unusable. Two case reports will be presented, which illustrate how freezing cold injury (FCI) of amputated digits may decrease the viability of such digits following replantation, and discuss the potential benefit of hyperbaric oxygen therapy (HBOT) in treating FCI of amputated digits following replantation. During the period 1998 to 2002, 124 injured individuals with severed digits were admitted to the Department of Plastic Surgery and Burns at the Ljubljana Clinical Centre. During this period, the number of attempted replantations increased from 29% in 1998 to 48% in 2002. The success rate of these replantations was 81%. Cold injury to the amputated parts was a significant factor affecting the replantation success rate in six patients. In all these cases, all fingers with the exception of the thumb were severed, and placed on ice for preservation during the transportation to the hospital. In all cases, the amputated digits suffered FCI, which was noted after successful replantation. In one patient we assessed the benefit of administering HBOT to treat FCI of the replanted digits. Signs of FCI appeared three days after replantation. One patient received HBOT 7 days after replantation, whereas the others did not. Due to oedema and progressive necrosis observed in the replanted fingers of these patients, reamputation was necessary in most cases. The detrimental consequences of inappropriate preservation of the severed fingers at subzero temperatures were: non-freezing tissue damage, arterial and venous thrombosis during the microsurgical procedure, and longer operations. Post-operatively, improper preservation during transport caused complications associated with freezingand non-freezing cold injury, despite successful reinstatement of perfusion to the replanted digits. Proper preservation of amputated body parts is essential for successful replantation. Hypothermic preservation is appropriate, if conducted properly. Since digits contain no muscle tissue, irreversible damage appears after significantly longer periods of ischaemia than in other types of tissue. Although we did not observe any benefit of HBOT in one patient, this is most likely due to the delay in initiating the treatment. HBOT should be administered immediately post-surgery, both to minimise reperfusion injury and freezing/non-freezing cold injury.