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A nine-finger discount
Does you accountant have nine fingers? If so, get another one! However, losing a
finger is a messy, painful experience, and usually associated with work. There
are about 10,000 cases of job-related amputations in the United States each
year; 94 percent of these involve fingers. Few statistics are available for the
outcome of replantations, but with microsurgery the success rate is increasing.
I did read a report on a series of 208 digital replantations from the frigid
zone within the People’s Republic of China. The extremely cold climate (down to
30 degrees below) presents the additional problem of warming the amputated
digits prior to replantation without causing further damage. An overall
replantation survival rate of 94 percent was reported, and this included 45
cases of multiple digit amputation. Clever people, these Chinese, but you never
know, they might have been ‘copy’ fingers.
Now, to successfully sew the finger(s) back on needs the patient to appear
fairly smartly at the hospital, and to also bring the missing digit. Despite
some claims to the contrary, we are not yet at the stage of being able to grow
you new fingers.
I was reminded where an injured person arrived at ER with his nine good fingers,
but without the 10th one that had been lopped off. The wound was clean and so
the hand surgeon sent the patient’s friends off to find the missing finger, as
there was a good chance of successful replantation. They appeared later with a
bag of chicken giblets straight from the refrigerator, proclaiming the missing
digit was inside. When the surgeon looked, the bag of chicken pieces, which
still had the name of the supermarket on it, had not been opened! There was
certainly no finger inside with the giblets, and all that could be done was to
trim up the traumatic amputation, and hope that the patient was not an
accountant.
So, provided the chap’s friends had managed to locate the missing finger, how do
you transport missing body parts (people lop off more than their fingers, let me
assure you). To save the tissue from further damage, keep the amputated finger
wrapped in clingfilm, preferably in a jar or cup with a lid. Do not put it
directly in water as this will cause it to shrivel up and become unusable for
the surgeon trying to reattach the finger. Put the container with the finger or
whatever inside another large bag with cold water, to keep the amputated part
cold. Some authorities say ice water, others say just cold water, and I tend to
go along with the ‘cold’ concept.
Be sure to gather up all parts of a severed digit, no matter how small. The body
cannot grow a new nail bed, the tissue directly under the nail, so being able to
use the original tissue makes a big difference to whether a full reconstruction
can take place.
Generally, the tissues will survive for about six hours without cooling, and if
the part is cooled, tissue survival time is approximately 12 hours. Fingers, by
the way (and not chicken giblets) have the best outcome for transportation
survival, since fingers do not have a large percentage of muscle tissue.
The micro-surgery required to successfully replant fingers (and the other bits
that get lopped off and offered to the ducks) is very exacting, as nerves,
arteries and veins all have to be reconnected. Very often the surgeon has to
shorten the finger, so that there is no tension on the sewn up structures. All
this takes an enormous amount of time and patience. With one celebrated case in
the UK, a woman lost six fingers and it took a team of surgeons working in
relays to reattach all six fingers during 17 hours of microsurgery. It is said
to be the first time so many fingers have been replanted in one operation.
Many other factors are involved in whether there is a successful outcome.
Generally, severe crushing or avulsing (tearing away) injuries to the fingers
make replantation difficult. Additionally, older persons may have
arteriosclerosis impairing circulation, especially in small vessels.
But if you are unfortunate to cut off a finger, remember to bring it with you,
not the chicken giblets!
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