Diagnosis of traumatic amputation is an easy one to make when a limb or appendage is completely severed; however, when partial amputation occurs, it must be determined how much of the affected appendage can be salvaged. This is crucial as salvaging a limb or appendage can mean the difference in how much function the victim will have in the future.

Any type of traumatic amputation begins with careful monitoring of the victim’s vital signs for signs of shock. Profuse bleeding can occur and can lead to hypovolemic shock if not treated promptly. Hypovolemic shock refers to shock caused by a sudden loss of blood volume. Traumatic amputation of more than a finger or a toe requires assessment of airway, breathing, and circulation, as any of these may be compromised.

Blood should be drawn for measures of hemoglobin and hematocrit. The victim should be typed and cross-matched in the eventuality that the victim may require a blood transfusion. Additionally, x-rays of the affected limb or area should be done to determine the extent of bone injury. Physicians should be vigilant for other injuries that may have occurred as a result of the trauma, such as chest or abdominal injuries that may not be readily apparent.

In partial amputation, pulses distal to the amputation should be checked and monitored. This may require the use of a Doppler device if pulses cannot be felt by hand. Loss of pulses may indicate that rapid surgical intervention is needed.

If a limb is to be removed surgically, diagnosis then focuses on determining the proper level of amputation, with the goal of preserving as much of the limb as is possible. The task becomes finding the level of amputation where healing will be most likely to be complete.

Ideally, any victim who has a partial or complete traumatic amputation of a limb will be cared for at a hospital or trauma center where personnel and equipment to care for this type of injury are readily available. Sometimes this level of care is not easily available due to geographic location.

Several tests may be done to assess the level and quality of blood flow through a limb. These tests may be used to assist a physician is determining how much of a limb may be salvaged. Some of these tests may only be available in larger centers or trauma facilities:

• Blood Pressure-Blood pressure can be measured in several areas of the limb to assess blood flow.
• Xenon 133- This test involve the use of radioactive material to study blood flow.
• Oxygen Tension- An oxygen probe placed under the skin helps determine where healing has the best chance to occur, based on measures of oxygen pressures.
• Skin Fluorescent Studies- These tests measure and assess the circulation of the victim’s skin.
• Skin Temperature Studies- Using infrared technology, it can be determined where the areas of greatest blood flow are.

As mentioned, victims of large traumatic amputations, such as a limb, should be considered for transfer to larger centers (trauma centers ideally) where physicians and equipment are readily available to treat such injuries.