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 [email protected].