Muscles are the least tolerant of ischemia and undergo irreversible changes after 6 hours. Because the digits lack muscle, the permitted duration of warm ischemia is up to 12 hours. If the amputated digit is cooled, the period of ischemia extends past 30 hours (Beasley, Aston, Bartlett, Gurtner, & Spear, 2007; Beris et al., 2009).