Traumatic amputation.

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Traumatic amputation.

Post by IAmOne » Sun Mar 21, 2021 11:13 am

An example of the odd things that drift through my head while I'm watching sports on the sofa of a Sunday.

In "normal" times, if I were hiking and came across a casualty who had suffered a clean traumatic amputation of, say three of his fingers, would the use of chemical coagulant or coagulant impregnated dressing affect the viability of a microsurgeon being able to reattach his missing digits?
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Re: Traumatic amputation.

Post by Vicarious_Lee » Mon Mar 22, 2021 4:42 pm

This is outside my scope, but after quickly DuckDucking some keywords, the answer is "probably". The articles I found about replantation of digits lean heavily on anti-coagulation in any small-part replantation. So, extrapolating....the better thing to do would be to bandage it adequately and if it's still bleeding too much, clamp down on the radial or ulnar artery depending on the fingers.

In surgery, the general rule is that a tourniquet can be clamped for two hours before it needs to be released for a few minutes to re-perfuse the area, without inviting more tissue necrosis. So if you had a big hike out....maybe do that but honestly call 911 as soon as you get a signal because those severed fingers have the clock ticking on them, even on ice. Like 6 hours if I remember correctly...nope, it's 12 for fingers, 6 with any part that has muscle tissue in it, which fingers do not.
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Re: Traumatic amputation.

Post by VXMerlinXV » Mon Mar 22, 2021 6:08 pm

I think VL hit all the major points, I’ll be honest I’ve been head scratching over this one since you posted it. So, theoretically yes, it could complicate reattachment, buuuuut it’s really hard to exangunate out of your fingers, so if they need hemostatics it’s life over limb. Plus, disaster or back country, those digits are on a real countdown timer. So their use could be problematic, but anolog world, it may not matter.
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Re: Traumatic amputation.

Post by woodsghost » Mon Mar 22, 2021 8:21 pm

I could be wildly ignorant here, so I'm posting where I can easily be corrected,...

I thought a cleanly severed limb...or fingers...had minimal bleeding? I thought it was the still partially attached pieces which bleed a lot and would be at more risk for needing a coagulant?
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Re: Traumatic amputation.

Post by CrossCut » Tue Mar 23, 2021 6:01 am

woodsghost wrote:
Mon Mar 22, 2021 8:21 pm
I could be wildly ignorant here, so I'm posting where I can easily be corrected,...
Ditto.
woodsghost wrote:
Mon Mar 22, 2021 8:21 pm
I thought a cleanly severed limb...or fingers...had minimal bleeding? I thought it was the still partially attached pieces which bleed a lot and would be at more risk for needing a coagulant?
That's my understanding too, or at least that a completely severed vessel will naturally retract, constrict, and clot easier where a partially severed one usually hemorrhages more and is harder to control.

Life over limb as VXMerlinXV said, but would think that the ED and surgeon would prefer hemostatic gauze over the granular powder type agents just because it's easier to debride the wound(s) and less risk of causing additional damage when doing so, and older hemostatic agents that produced heat should be avoided as they might cause thermal damage and make replantation more difficult. My non-medically trained .02 only.

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Re: Traumatic amputation.

Post by IAmOne » Wed Mar 24, 2021 2:37 am

My sole experience was several decades ago when, during an exercise to build a rope bridge across a stagnant pond full of man eating frogspawn, a fellow cadet severed a finger with his treebasher, as I recall there was quite a bit of blood!
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Re: Traumatic amputation.

Post by Albert » Wed Mar 24, 2021 3:57 pm

The only experience I have is when, four decades ago or so, an acquaintance ran his hand through a bandsaw, resulting in a quite clean amputation. In his case, he put pressure on the stub, and put the end of his hand/fingers in ice-water, to keep them cool, and, thus, slow tissue degradation, until he could be airlifted to a major trauma hospital, where the end of his hand was successfully reattached. Now, admittedly, things may have changed in the last four decades, but it worked.

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Re: Traumatic amputation.

Post by RoneKiln » Mon Jun 21, 2021 12:00 am

Ooh! I just took a class on this!

But I am not a professional.

In class I was told the older products like Quickclot would impair surgical repair, while the newest products like Hemcon would not impair surgical repair.

Remember, I am not a professional. I'm just a lunatic that took a one day course on this in case something goes wrong at the range.

We were taught that if you can get someone to an OR within 7 hours, just put a tourniquete on a limb that is bleeding badly. Hiking can mean a lot of different things to different people, so I guess it's possible you might be more than 7 hours from getting someone to the OR that fast and it might be worth using Quickclot if you have it.
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Re: Traumatic amputation.

Post by MacWa77ace » Tue Jun 22, 2021 3:54 pm

Not an amputation, but regarding a puncture wound. What if you filled a puncture wound with quick clot or stuffed it with some hemo-gauze. Would that impair the wound from healing correctly in the long run and create a divot or crater scar?

I knew this guy that was shot thru and thru in the lower leg and, well, small entry large exit, and he had about a 3 inch crater with a crack in it in the middle of his calf. I took him to hydro therapy a couple times, but never saw the wound 100% closed and healed so don't know the final result. At that time I didn't ask if they used any of the hemostatics on the scene for him or just TQ, pressure and gauze. But the back of his leg did not look good.
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Re: Traumatic amputation.

Post by RoneKiln » Sun Jun 27, 2021 11:36 pm

MacWa77ace wrote:
Tue Jun 22, 2021 3:54 pm
Not an amputation, but regarding a puncture wound. What if you filled a puncture wound with quick clot or stuffed it with some hemo-gauze. Would that impair the wound from healing correctly in the long run and create a divot or crater scar?

I knew this guy that was shot thru and thru in the lower leg and, well, small entry large exit, and he had about a 3 inch crater with a crack in it in the middle of his calf. I took him to hydro therapy a couple times, but never saw the wound 100% closed and healed so don't know the final result. At that time I didn't ask if they used any of the hemostatics on the scene for him or just TQ, pressure and gauze. But the back of his leg did not look good.
According to the one day class I took, "just throw a tourniquet on it and get them to the operating room." Again, quickclot could impair recovery but the newer anticoagulants won't.

But if that puncture wound is on the torso, and I have quickclot available, I'm using the quickclot. You've got to keep them from dying before you can worry about their recovery. If I'm not sure of the balance between severity of injury and time to the OR, I'm not overthinking it. I'm using the quickclot.

But when I ordered bandages recently, I didn't order quickclot ones. I ordered the Hemcon ones.

Again, I am not a profesional. I have never treated gunshot wounds. I am only a lunatic on the internet that took a single one day class.
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Re: Traumatic amputation.

Post by Vicarious_Lee » Mon Jun 28, 2021 10:12 am

Ooh! Relevant topic before the boards are killed forever!

On Friday my 8 y/o's left thumb was almost ripped off by a zebra. The plan during the split second he was being dragged through the fence and before I could yank his arm out of it's mouth was to compress the radial artery, retrieve the thumb, irrigate with a bottle of water in the back of the Polaris, put the thumb on ice, and start trying to find a COMPETENT hand surgeon as short a distance away as possible.

This happened in Branson, so I was probably gonna have to make the drive to St. Louis.

But then the zebra let go.
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