What is the best way to store and prepare a severed digit for reattachment?

Proper Storage and Preparation of a Severed Digit for Reattachment

For optimal survival of a severed digit, it should be wrapped in saline-soaked gauze, placed in a specimen jar, and then placed in a plastic bag containing ice and water to maintain a temperature of 4°C (±2°C). 1

Initial Management of the Amputated Digit

Handling the Digit

• Handle the digit by the edges only, avoiding contact with the cut surface 2
• Do not scrub, brush, or use antiseptics on the amputated part
• If visibly dirty, briefly rinse (less than 10 seconds) with clean water 2
• Do not soak the digit in any solution

Proper Storage Method (Step-by-Step)

1. Wrap the digit in clean, saline-soaked gauze 1
2. Place the wrapped digit in a watertight container (specimen jar or sealed plastic bag) 1
3. Place this container into a second bag containing ice and water 1
4. Ensure the digit is not in direct contact with ice to prevent freezing injury 1

Temperature Considerations

• Target temperature for preservation: 4°C (±2°C) 1
• Direct contact with ice can cause frostbite and tissue damage 2
• Room temperature storage leads to rapid tissue deterioration
• The "bag-in-bag with ice water" method maintains optimal temperature for approximately 225 minutes 1

Transport Considerations

Time Factors

• Ischemia time is critical for successful replantation
• Cold ischemia time (properly cooled digit) should ideally be less than 12 hours
• Warm ischemia time (room temperature) should be minimized as much as possible

Communication with Medical Facility

• Contact the receiving medical facility immediately
• Inform them about:
  • Time of amputation
  • Storage method being used
  • Estimated arrival time
  • Patient's condition

Special Considerations

What to Avoid

• Do not place the digit directly on ice 2
• Do not store in plain water (causes osmotic damage)
• Do not use alcohol, antiseptics, or other chemicals
• Do not attempt to clean the wound beyond gentle rinsing 2
• Never discard the amputated part, even if severely damaged 3

Indications for Replantation

Replantation should be considered for:

• Thumb amputations
• Multiple digit amputations
• Amputations at or proximal to the proximal interphalangeal joint
• Amputations of the wrist or hand 3

Post-Replantation Monitoring

After replantation, healthcare providers will monitor for:

• Arterial insufficiency (pale, cool digit with poor capillary refill)
• Venous congestion (bluish discoloration, swelling) 4
• Signs of infection

Pitfalls and Caveats

• The most common mistake is placing the digit directly on ice, which can cause freezing injury
• Failure to properly wrap the digit can lead to desiccation (drying out)
• Improper temperature control significantly reduces viability
• Even severely damaged digits should be preserved and transported as they may contain viable tissue for partial replantation 3
• The "bag-in-kidney dish" method performs poorly, with the slowest cooling and shortest duration at target temperature 1

Remember that proper storage and rapid transport to a facility capable of microsurgical replantation are critical factors in determining the success of digit reattachment.