Misplaced fingers! What to do

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Thailand is infamously known as a culture where certain anatomical bits have been lopped off by unhappy ladies. Following retrieval, re-attachment generally does go well (the Bobbit operation), but much depends on the offending bit being viable.

However, there are other anatomical items that become severed. 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 modern surgery the success rate is increasing.

I did come across a report on a series of 208 digital replantations from the frigid zone within the People’s Republic of China. The extremely cold climate (30 degrees below) presents the additional problem of warming the amputated digits prior to replantation. 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, were they ‘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 new fingers for you.

Recently, 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, how should you transport missing body parts (people get more than fingers lopped off)? To save the tissue from further damage, keep the amputated bit wrapped in cling film, 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 it. 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 were 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 avulsion (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!