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Difficulty: MediumTrauma and Burns

A 28-year-old carpenter is brought to the emergency department after accidentally severing his right index finger with a table saw. The amputated digit was recovered at the scene and brought to the hospital by coworkers in a dry tissue paper. The patient is hemodynamically stable, and a trauma primary survey reveals no other injuries. The emergency department team is preparing the amputated digit for transport with the patient to a specialized microsurgery center. Arrange the following steps for the proper preservation and transport of the amputated digit in the correct chronological sequence.

  1. 1Gently irrigate the amputated digit with sterile saline to remove gross debris.
  2. 2Wrap the amputated digit in sterile gauze moistened with isotonic saline.
  3. 3Place the wrapped digit inside a sealed, watertight plastic bag.
  4. 4Submerge the sealed plastic bag in a container filled with an ice-water slush.

Answer

The correct sequence for preserving an amputated digit is to first gently irrigate the part with sterile saline, then wrap it in saline-moistened gauze, seal it inside a watertight plastic bag, and finally submerge the sealed bag in an ice-water slush.
Proper preservation of an amputated digit aims to minimize warm ischemia time while preventing secondary tissue damage from desiccation, maceration, or frostbite. The sequence ensures the tissue is physically clean (irrigation), kept physiologically moist but not waterlogged (moist gauze), protected from environmental fluid (sealed bag), and optimally cooled without freezing (ice-water slush).

Step-by-Step Solution

1
Irrigate the amputated digit with sterile saline.
Removes gross environmental contaminants from the wound surfaces.
Decreases the microbial load and risk of subsequent infection before the digit is sealed for transport.
2
Wrap the digit in saline-moistened sterile gauze.
Creates a protective, humidified microenvironment around the tissue.
Prevents desiccation (drying out) of the skin, nerves, and underlying microvasculature.
3
Place the wrapped digit into a watertight plastic bag.
Creates a waterproof barrier between the tissue and the cooling medium.
Prevents direct exposure to the ice water, which would cause tissue maceration and hypotonic cellular damage.
4
Submerge the sealed bag in an ice-water slush.
Lowers the tissue temperature to the optimal range of 1 to 4 degrees Celsius.
Decreases cellular metabolism, significantly extending the permissible warm ischemia time (up to 24 hours for digits) while strictly avoiding direct freezing/frostbite.

Key Concept

Preservation of amputated digits for replantation
Estimated Time:1m 30s
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Topics

Trauma and Burns

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