Amputation is the medical terminology used to describe the traumatic or surgical removal of a limb. This removal can be prompted by disease such as cancer, trauma or peripheral vascular disease secondary to diabetes.
The most common amputations are of the lower limb and feet. There are 50,000 new amputations every year in the United States based on information from the national Center for health statistics. The ratio is one upper limb to four lower limb amputations with the most common upper limb being a partial hand amputation with the loss of one or more fingers.
The amputation of wrist and hand is estimated to make up only 10% of the upper limb amputations which is again only 25% of the total number of individuals who experience an amputation. Some of the more common reasons include cardiovascular disease, traumatic accidents, infections, tumors and nerve injury. The most frequent causes are trauma and cancer with the right arm being more frequently involved in work related injuries.
Following a traumatic injury, if it is feasible, surgeons will attempt a replant. This means that is severed body parts will be reattached and preserve the quality of function and appearance. The first of these was attempted 40 years ago and since then thousands have been reattached. Ronald Malt performed the first re-plantation in 1962 at Massachusetts General Hospital on a 12-year-old boy.
Since these first surgeries technological advances and the use of the microscope has made replantation of other parts possible. However, although possible in some cases not all individuals who experience a traumatic amputation will benefit or will be candidates for replantation. The decision is influenced by the part of the body, the level of the injury, the expected return of function and the mechanism of the injury. Functional outcomes will vary with the level of injury and the part of the body injured.
When a hand is badly injured or subject to disease, the goal is to restore as much function and form as possible to minimize the appearance of the loss. We rarely consider the tremendous contribution of our hands to both our body image and the function we expect on a daily basis. An injury to the hand that requires an amputation involves much more than just the physical loss, it is also a profound emotional loss.
This prosthetic devices currently available for people who have had a partial hand amputation are diverse and individualized to the specific needs of the person. Prosthetists attempt to prevent pain and joint problems as well as improve the function and activities. Residual appearance is also a concern because it is such a significant part of our self-image.
In spite of this fact, there are no two surgeons who will do the same things exactly alike in the case of a full or partial hand amputation. There is no single way of managing an injury that is vastly superior to any other. These different treatment options have different supporters in the medical community. Physicians will have different points of view and philosophies related to the ability of the remaining hands to become functional and achieves the goal of daily activities.
Once the amputation is completed and the individual is fitted for a prosthesis they will also undergo extensive rehabilitation in order to teach them to use them both the remaining part of the hand as well as a prosthetic in order to successfully complete their daily living activities.