Transferring a patient for hand trauma

University of Iowa Hospitals & Clinics provides 24/7 microvascular surgical repair for hand injuries.

Injuries that may require transfer

  • Amputations
  • Blast injuries
  • High-pressure injuries
  • Crush injuries
  • Avulsions
  • Detachment injuries
  • Complicated lacerations
  • Tendon injuries
  • Nerve injuries
  • Hand fractures
  • Wrist fractures
  • Pediatric upper extremity trauma

Patients who may benefit from replantation

  • Any pediatric patient

Patients with any of the following:

  • Amputation through the hand, proximal to the hand
  • Thumb amputation
  • Multiple-digit amputation

Patients unlikely to benefit from replantation

Those with:

  • Mangled limb with extensive tissue loss
  • Crush injury with extensive tissue loss
  • Segmental amputation
  • Medical instability
  • Severe tissue contamination

Pre-transfer care of injured parts (adults and children)

Amputated parts should be:

  • Placed in saline soaked gauze
  • Sealed in plastic bag and transported on ice

Non-amputated limb:

  • Limb should be dressed and kept warm, with hemostasis achieved.
  • Prophylactic tetanus and antibiotics should be administered.

Replant pre-operative patient education

The replantation process is augmented by patient education at the initial stage of injury. The final decision regarding replantation versus amputation will be made intra-operatively. Patients should be informed that replantation:

  • Cannot be confirmed until the surgeon has evaluated the injury in an operative setting
  • Will likely result in a 5-7 day hospitalization
  • Requires additional surgical procedures in more than 60 percent of the cases
  • Will likely require 3 to 6 months off work with return to limited duty and extensive physical therapy
  • Will result in altered motor, sensation, and cold tolerance; deficits that improve with time

Patient transfer protocol

Call the admission and transfer center at 1-866-890-5969. You will be connected with a hand team member on call who can discuss the patient’s condition and accept transfer if indicated.

Email pictures of the injured extremity to handtrauma@uiowa.edu.

Hand trauma reference sheet

Last reviewed: 
October 2018

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