eMedicine Specialties > Orthopedic Surgery > Hand & Upper Extremity

Digital Amputations

Author: Bradon J Wilhelmi, MD, Professor and Endowed Leonard J Weiner, MD, Chair of Plastic Surgery, Residency Program Director, University of Louisville School of Medicine
Contributor Information and Disclosures

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.

More on Digital Amputations

Overview: Digital Amputations
Treatment: Digital Amputations
Follow-up: Digital Amputations
Multimedia: Digital Amputations
References

References

  1. Louis DS, Hunter LY, Keating TM. Painful neuromas in long below-elbow amputees. Arch Surg. Jun 1980;115(6):742-4. [Medline].

  2. 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].

  3. 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].

  4. 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.

  5. 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.

  6. Raitliff AHC. Amputations of the fingers and thumb. Hand. 1969;1:137.

  7. Thompson RV. Essential details in the technique of finger amputation. Med J Aust. 1963;50:14.

  8. Chase RA. Functional levels of amputation in the hand. Surg Clin North Am. Apr 1960;40:415-23. [Medline].

  9. Ennis WM, Huber HS. Traumatic amputations of the fingers. Surg Clin North Am. 1938;18:305.

  10. 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].

  11. Parkes A. The "lumbrical plus" finger. Hand. Sep 1970;2(2):164-5. [Medline].

  12. 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].

  13. Swanson AB. Levels of amputation of fingers and hand -- considerations for treatment. Surg Clin North Am. Aug 1964;44:1115-26. [Medline].

  14. 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].

  15. 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].

  16. Datiashvili RO, Knox KR, Kaplan GM. Solutions to challenging digital replantations. Clin Plast Surg. 34(2);2007 Apr:167-75, vii. [Medline].

  17. 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

Contributor Information and Disclosures

Author

Bradon J Wilhelmi, MD, Professor and Endowed Leonard J Weiner, MD, Chair of Plastic Surgery, Residency Program Director, University of Louisville School of Medicine
Bradon J Wilhelmi, MD is a member of the following medical societies: Alpha Omega Alpha, American Association for Hand Surgery, American Association of Clinical Anatomists, American Association of Plastic Surgeons, American Burn Association, American College of Surgeons, American Society for Aesthetic Plastic Surgery, American Society for Reconstructive Microsurgery, American Society for Surgery of the Hand, American Society of Plastic Surgeons, Association for Surgical Education, Plastic Surgery Research Council, and Wound Healing Society
Disclosure: Nothing to disclose.

Medical Editor

Joseph E Sheppard, MD, Associate Professor of Clinical Orthopedic Surgery, Chief of Hand and Upper Extremity Service, Department of Orthopedic Surgery, University of Arizona Health Sciences Center, University Physicians Healthcare
Joseph E Sheppard, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Society for Surgery of the Hand, Clinical Orthopaedic Society, and Western Orthopaedic Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Robert J Nowinski, DO, Clinical Assistant Professor of Orthopaedic Surgery, Ohio State University College of Medicine and Public Health, Ohio University College of Osteopathic Medicine; Private Practice, Orthopedic and Neurological Consultants, Inc, Columbus, Ohio
Robert J Nowinski, DO is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Osteopathic Surgeons, American Medical Association, American Osteopathic Association, Ohio Osteopathic Association, and Ohio State Medical Association
Disclosure: Tornier Grant/research funds Other; Tornier Honoraria Speaking and teaching

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Harris Gellman, MD, Consulting Surgeon, Broward Hand Center; Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami School of Medicine
Harris Gellman, MD is a member of the following medical societies: American Academy of Medical Acupuncture, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Society for Surgery of the Hand, and Arkansas Medical Society
Disclosure: Nothing to disclose.

 
 
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