Limb Amputations and Prosthetics-Management of Upper Limb Amputations

Management of Upper Limb Amputations

Pdf Summary

Upper limb amputations beyond the finger can have significant physical, psychological, social, and economic consequences for the patient. The hand surgeon plays a critical role in the surgical management of these wounds to maximize the use of the residual extremity and minimize complications. The initial management of severe upper limb trauma must consider the overall condition of the patient and focus on wound assessment and debridement. Amputation should only be performed if the limb puts the patient's life at risk. Surgical options for upper extremity amputations proximal to the finger include preservation of length and joint function, use of skin grafts, dermal substitutes, filleted flaps, and free tissue transfer. The level of amputation depends on the patient's specific needs and the goals of reconstruction. Partial hand amputations should preserve 2 sensate digits that are able to oppose each other to allow for prehension. Wrist disarticulation preserves 100° to 120° of pronosupination and allows for the use of passive prostheses. Transradial forearm amputation is the most common level of upper extremity amputation and preserves adequate soft tissue coverage of the radius and ulna. Elbow disarticulation allows for rotational control of the prosthesis through the retained metaphyseal flares of the distal humerus. Above-elbow amputations should preserve at least 5 cm of the proximal humerus to maintain deltoid muscle function and improve prosthetic fit. Pediatric upper extremity amputations require special considerations due to ongoing growth and development. Surgical complications may include heterotopic ossification, wound infection, neuroma excision, scar revision, and contracture release.

Keywords

Upper limb amputations

physical consequences

psychological consequences

surgical management

complications

wound assessment

surgical options

proximal humerus

pediatric upper extremity amputations

surgical complications