Changes in perceptions regarding correct preoperative storage and transfer of amputated digits: A 5‐year follow‐up

Replantation of amputated body parts is a highly specialized, cost-intensive procedure and can offer significantly increased quality of life in selected cases. Continued technical innovation and experience have been reflected in a number of successful personal operative series being reported in the literature. In the absence of custom made devices for storage of the amputated part, prehospital preparation is often determined by the referring practitioner, prior to contact with the referring department. To optimize chances of successful replantation, appropriate preparation and transfer to the replantation center are critical. However, literature regarding perceptions about correct preoperative storage and transfer by referring practitioners is limited. Our intital study reported significant deviations from the advanced trauma life support (ATLS) guidelines in this regard, excluding suitable patients from replantation. In consideration of the increased penetrance of ATLS and equivalent courses in the medical community and the recent nationwide reconfigurations in health service delivery, we performed a 5-year follow-up survey (reaudit) to determine any changes in referring practitioner perceptions of this procedure. The survey was conducted on centers referring to the Welsh Centre for Burns and Plastic Surgery (n 5 16) between November 2012 and February 2013. To facilitate comparisons, the same semi-structured telephonic questionnaire and best practice guidelines (ATLS) as our earlier study were adopted (Table 1). A total of 68 healthcare practitioners were invited, of whom 51 responded (78% respondent rate), from 90% of referring units. The respondents included the following grades: consultant (14%), specialist registrar (12%), and core trainee=senior house officer (50%); foundation year= house officer (4%); nurse practitioner (10%); and acute care GP (10%). Of the respondents, only 25% described the entire procedure correctly. Of the remainder, only 4% remarked they would seek advice on storage of the amputated part before preparing for transfer. Labeling of the amputation with any identification details was mentioned by only 10% of respondents. A dry swab was preferred to a saline-soaked swab by 14% of respondents and 56% of the total would routinely trim and=clean the amputated part. Concerningly, 10% said the amputation could be stored directly on ice. Checking tetanus immunity status was only mentioned by 10% of respondents. Use of inappropriate solutions for cleaning=storage and transfer was reported by 4% of respondents. A wide variation was still observed in the perception of ischaemia with the time range of 1–12 hours, with a mode of 3 hours. This data is a cause for concern especially considering the relatively high proportion of middle=senior medical grade respondents (36%). While the limitations on inference and generalization from such a small descriptive study are well-established, this study affirms the onus on plastic surgeons to educate and collaborate with referring departments. In the majority of cases, decisions determining viability of the replant (direct storage on iceuse of abrasive=cytotoxic solutions) are actuated before contact is made with the receiving plastic surgeon. Data reported in this study suggest that, applied alone, educational engagement of referring centers reported in *Correspondence to: Ernest Azzopardi, Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea SA6 6NL, United Kingdom. Email: azzopardiea@cardiff.ac.uk Received 13 April 2013; Revision accepted 9 May 2013 Published online 2 August 2013 in Wiley Online Library (wileyonlinelibrary. com). DOI: 10.1002/micr.22142