by Dr. Iain Corness
Five and four equals nine (fingers)!
Accountants need ten fingers, so a nine
fingered one is pretty dodgy. However, every day there are people lopping
off one of their ten. 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 (down to 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.
I was reminded of this recently 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, if the chap’s friends had located the missing finger, 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 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
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!