eMedicine Specialties > Orthopedic Surgery > Hand & Upper Extremity
Digital Amputations
Updated: May 14, 2008
Introduction
An amputation is the removal of an extremity or appendage from the body. Amputations in the upper extremity can occur as a result of trauma, or they can be performed in the treatment of congenital or acquired conditions. Although successful replantation represents a technical triumph to the surgeon, the patient's best interests should direct the treatment of amputations.
The goals involved in the treatment of amputations of the upper extremity include the following: (1) preservation of the functional length, (2) durable coverage, (3) preservation of useful sensibility, (4) prevention of symptomatic neuromas, (5) prevention of adjacent joint contractures, (6) early return to work, and (7) early prosthetic fitting.1,2 These goals apply differently to different levels of amputation.
For excellent patient education resources, visit eMedicine's Hand, Wrist, Elbow, and Shoulder Center. Also, see eMedicine's patient education articles Finger Injuries and Hand Injuries.
Indications
Amputations can result from traumatic injury involving a variety of machines, they can be self-inflicted, or they may be required after traumatic events, such as electrical burns or frostbite. In addition, elective amputations may be indicated for tumor extirpation, vascular insufficiency, infection, or congenital malformation.
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References
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Conolly WB, Goulston E. Problems of digital amputations: a clinical review of 260 patients and 301 amputations. Aust N Z J Surg. Sep 1973;43(2):118-23. [Medline].
May JW Jr, Toth BA, Gardner M. Digital replantation distal to the proximal interphalangeal joint. J Hand Surg [Am]. Mar 1982;7(2):161-6. [Medline].
Omer GE. Amputation. In: Hunter JM, Schneider LH, Makin EJ, Bell JA, eds. Rehabilitation of the Hand. St Louis, Mo: Mosby-Year Book; 1978:541.
Wilhelmi BJ, Neumeister MW. Hand, finger nail and tip injuries. eMedicine from WebMD [serial online]. Updated June 28, 2006;Accessed March 10, 2008. Available at http://emedicine.medscape.com/article/1285680-overview.
Raitliff AHC. Amputations of the fingers and thumb. Hand. 1969;1:137.
Thompson RV. Essential details in the technique of finger amputation. Med J Aust. 1963;50:14.
Chase RA. Functional levels of amputation in the hand. Surg Clin North Am. Apr 1960;40:415-23. [Medline].
Ennis WM, Huber HS. Traumatic amputations of the fingers. Surg Clin North Am. 1938;18:305.
Whitaker LA, Graham WP 3rd, Riser WH, Kilgore E. Retaining the articular cartilage in finger joint amputations. Plast Reconstr Surg. May 1972;49(5):542-7. [Medline].
Parkes A. The "lumbrical plus" finger. Hand. Sep 1970;2(2):164-5. [Medline].
Murray JF, Carman W, MacKenzie JK. Transmetacarpal amputation of the index finger: a clinical assessment of hand strength and complications. J Hand Surg [Am]. Nov 1977;2(6):471-81. [Medline].
Swanson AB. Levels of amputation of fingers and hand -- considerations for treatment. Surg Clin North Am. Aug 1964;44:1115-26. [Medline].
Jones ML, Blair WF. Salvage of a below-elbow amputation stump with a free latissimus dorsi muscle flap: a case report. J Hand Surg [Am]. Mar 1994;19(2):207-8. [Medline].
Klein-Weigel P, Pavelka M, Dabernig J, et al. Macro- and microcirculatory assessment of cold sensitivity after traumatic finger amputation and microsurgical replantation. Arch Orthop Trauma Surg. Jul 2007;127(5):355-60. Epub 2007 Jan 20. [Medline].
Datiashvili RO, Knox KR, Kaplan GM. Solutions to challenging digital replantations. Clin Plast Surg. 34(2);2007 Apr:167-75, vii. [Medline].
Dautel G, Barbary S. Mini replants: fingertip replant distal to the IP or DIP joint. J Plast Reconstr Aesthet Surg. 2007;60(7):811-5. Epub 2007 May 23. [Medline].
Further Reading
Keywords
finger amputations, upper-extremity amputations, arm amputations, ray amputations, finger replantation, thumb amputations, transcarpal amputation, wrist disarticulations, Krukenberg procedure, above-elbow amputation, below-elbow amputation, elbow disarticulations
Overview: Digital Amputations