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Don't panic! - a severed finger can be successfully reattached

By dpa news     Oct 7, 2007 in Health
The sight of a finger that has been suddenly severed is traumatic for both the victim and onlookers yet there is no need to panic. Tens of thousands of people a year lose a digit in accidents at home and work and in most cases the finger can be successfully reattached by surgeons.
Accidents involving chain saws or axes used for wood chopping are among the most common - at home or in the workplace. The power tools used in the woodworking industry also pose a particular hazard although there are plenty of dangers lurking at home too.
Fingers can be crushed in doors, injured by being struck against something or else cut or pierced by an object. Chopping vegetables puts digits at risk along with clearing debris from a lawnmower or simply using a paper shredder.
When an accident occurs, the most important thing is to secure the amputated finger as quickly as possible, explains Andreas Eisenschenk who works at the casualty unit of a hospital in Berlin. He is also secretary of the German Society for Hand Surgery.
The window of opportunity can stay open for up to 12 hours but it depends on how badly the finger has been injured. It may sound grim but finding the severed body part on the ground "is also particularly important when dogs and cats are around," says the expert.
The detached digit must be packaged in such a way that it can be sewn back on again by surgeons. Ensuring a sterile environment is not so vital, says Eisenschenk since the affected body part has usually already come into contact with dirt and will be thoroughly sterilised before being reattached.
Initially it is enough to wrap the severed finger in a handkerchief or a moist paper towel and wait until paramedics arrive to put it in an ice-filled bag.
If help is not immediately available, Hartmut Siebert, General Secretary of the German Society for Accident Surgery (DGU), recommends using any watertight plastic bag or kitchen clingfilm.
The detached digit and any related tissue parts should be placed inside just as they are and the bag firmly closed. It should then be put inside another separate sealed bag containing either ice or cooled water.
"The detached part must however not come into direct contact with cold water or ice," says Siebert. The ideal water temperature is between 4 and 5 degrees.
In most western European countries the medical infrastructure is such that a qualified surgeon is present in hospital to sew the severed digit back on as soon as possible. Until then it is important to tend to the wound.
"Under no circumstances should the wound be compressed or bound. The main thing is to keep the injured hand held up since this helps stem the bleeding," says Siebert, commenting that it was extremely rare for a person to bleed to death after losing a digit in an accident.
The chances of a surgeon being able to reattach a severed finger depend very much on the type of wound suffered. Smooth cuts leave the tissue in relatively good condition and ease the operator's work. A finger chopped off with a clean cut is the easiest to reattach, whereas the damage caused by a chainsaw leaves serrated wound edges and puts more strain on the small blood vessels and nerves.
A severely crushed digit or one which has been torn away is the most difficult of all to reattach and in some cases the tissue has been so badly damaged that the surgeon is unable to help.
Once in the operating room, doctors will take an interest in the livelihood and hobbies of the patient.
"In the case of a construction worker working outside, we would not advise sewing back on the severed little finger of a hand unless the person insisted on it," said Eisenschenk. Reattached fingers generally remain very sensitive to cold temperatures.
Assuming the surgeon decides to go ahead with an operation, the chances of successful reattachment stand at around 80 per cent. An operation is only considered a success, if the feeling returns to the affected digit.
A typical microsurgery operation to reattach a finger starts with cleaning the wound and with the removal or dead or damaged tissue in a process known as debridement. The bone is then stabilised with sutures and sometimes held in place with wires before the tendon is reattached. The arteries and veins are rejoined under a magnifying glass or microscope and the skin is repaired last of all. A vein graft can be used for blood vessels that cannot be reattached.
An experienced replantation team can complete an operation like this within three hours, said Andreas Eisenschenk. Most operations can be carried out under local anaesthetic.
The wound usually heals within three weeks and after three months full movement should have been restored. It takes up to six months for feeling to return to the damaged digit since nerves grow only slowly.
Problems arise when the detached finger cannot be found or it turns out to be too badly damaged for reattachment. Doctors then have to discuss the situation with the patient and decide what is best in order to ensure the victim retains a high level of manual dexterity.
The thumb is considered the most important digit of the hand followed by the forefinger and the little finger. The middle or ring fingers are not so essential.
To ensure a repaired hand functions as well as possible, surgeons aim to retain the so-called three-point grip, namely the ability to bring thumb, forefinger and little finger together. If a thumb is missing, it is even possible to remove a person's toe and transplant it to the hand as a replacement. dpa/tmn pe tk cf mb pb ds