This elearning course provides a step by step approach, lessons on objectives, preoperative information and postoperative complications, procedural anatomy and a test. First and second ray amputation surgical indications and considerations anatomical considerations. Most of the included studies suggest that for those worse cases ray amputation still represent a good option. Using the pubmed database we made a systematic search for articles regarding single ray amputation after traumatic hand lesion. There is extensive amputation and fractures of the second to fifth fingers. A forefoot amputation can sometimes be helpful in patients with more than one toe involved by gangrene. Amputations amputations are widespread and involve a variety of activities and equipment. Amputation is a procedure of last resort and is indicated only after limb salvage options have failed.
Each year, thousands of workers lose fingers, hands, feet, and other body partsmostly through compression, crushing, or by getting them caught between or struck by objects. Amputations of the upper extremity largely follow the same basic principles as those of any amputated limb, some of which are covered in this article. Modified technque for radical transmediastinal forequarter ampuation and chest wall resection. Pdf single ray amputation after hand trauma or infection can result in good aesthetic and functional outcomes. The functional consequence of any particular amputation is the primary. Occasionally, traumaticallyamputated fingers may be replanted reattached. Minor amputations generally refer to the amputation of digits. Although double ray amputation results in worse functional outcome than single ray, good key, tip, and tripod pinch can be preserved when the deep motor branch of the ulnar nerve is preserved, and this hand can still assist in bimanual hand activities. Biology anatomy abstract the south dakota state university anatomy program received a male cadaver, age eightyfour, in january 2014.
Hand and finger injuries continue to be very common problems in emergency departments ed around the world. Learn about the hand ray amputation, an online 3dvideobased course, accredited by the royal college of surgeons of england. Winograd, md, facep, attending physician, department of emergency medicine, lakeland regional health system, st. In this operation all of the toes and the ball of the foot are removed. Oct 02, 2019 the principles of a central ray amputation include removal of the injured finger at the metacarpal base, correcting the rotational deformity, closing the space between the 2 adjacent unamputated fingers, and achieving a satisfactory appearance of the hand. Ring avulsion are relatively common hand lesions and are associated with significant disability. Amputation should be used sparingly and for very limited indications. Upper extremity amputations and prosthetics thieme connect. Amputation in hand surgery medical journal of malaysia. To assess patient satisfaction, functional and cosmetic outcomes of singledigit ray amputation in hand and identify factors that might affect the outcome. Interestingly, the additional level of resection did not occur more proximally along the first ray itself but rather involved a separate digit 32 37. Surgical incision a long plantar flap results in a better endbearing stump.
Aug 05, 2009 partial hand amputations, in the form of a single or double ray amputation, offer a good oncologic solution with function superior to more proximal level amputation. Amputation is the surgical removal of part of the body, such as an arm, hand, leg or foot. We describe a technique for amputation of the affected ray at the proximal metacarpal metadiaphyseal flare and a concomitant closing wedge osteotomy to allow. The traditional partial fifth ray amputation technique didfor treatment of wounds isolated to the fifth toe and metatarsal neuropathy,phalangeal joint mpj area involves removal of the fifth toe and metatarsal head. Meeting the challenge of partial hand amputations leonard f. Partial hand wrist or forearm almost any part in a child. Her anklebrachial index abi for her right posterior tibial artery is 0. However, the survivorship of partial first ray amputations. The majority of lower extremity amputations are performed for lower extremity ischemia peripheral artery disease, embolism and diabetes mellitus.
Ray resections have been a viable treatment option for patients with. It results in delayed healing of wounds, more extensive tissue damage, an increased length of stay in the hospital, and higher mortality. Surgical technique utilizing suturebutton device for central. A websaving skin incision for amputation of the third or fourth ray of the hand m. The goal with partial fifth ray amputation is to maintain at least 50% of the proximal fifth metatarsal morewith. More than 90% involve the fingertip pulp, fingernail, andor distal phalanx only and are treated and released in an ed. Third metacarpal shortening osteotomy to improve hand. The functional results of ray amputation hand surgery. As a surgical measure, it is used to control pain or a disease process in the affected limb such as a malignancy, infection or gangrene. Ray amputation therefore results in narrowing of the hand that can decrease grip. As a surgical measure, it is used to control pain or a disease process in the affected limb, such as malignancy or gangrene. In the united states, finger amputations are very common in both the work environment 1 and in the home.
Introduction amputation is the most ancient of surgical procedure. There were 14 border eight index, six little and six central ray five middle, one ring amputations. Lower extremity amputation is performed to remove ischemic, infected, or necrotic tissue or locally unresectable tumor and, at times, may be lifesaving. However, the primary purpose of this article is to highlight the special considerations involved in acquired amputations at the wrist see the image below and forearm below the elbow. Several prosthetics solutions are available for this level of amputation including passive, bodypowered, myoelectric, hybrid systems and activity specific systems. Amputations in the hand are commonly the result of a traumatic injury but may be the result of a planned operation to prevent the spread of disease in an infected finger or hand. Amputation is no longer a crude ablational surgery but a refined reconstructive procedure to prepare the stump for its motor functions,sensory feed back and cosmesis. Finger amputation cpt code medical billing and coding. Charles stewart, md, facep, associate professor of emergency medicine, university of rochester school of medicine, rochester, ny. Amputation a m p u t a t i o n m a r d i g i a n w e l l n e s s r e s o u r c e c e n t e r page 1 the purpose of this guide is to help patients and families find sources of. Second ray shifted to the third ray toeliminate gap. Although the role of single ray amputation for treatment of traumatic hand injuries and hand infection is well established 7, 14, 17, 19, 20, its functional and oncologic outcomes for management of hand tumors are not as well defined.
Maximize the length of the amputation stump free tissue transfer to retain length forearm. A painful proximal phalanx amputation stump of the middle or ring finger that is fixed in extension, an amputation of the metacarpophalangeal joint, which allows small objects to fall from the palm, or an aesthetically displeasing stump must be revised by using a ray deletion. Second ray shifted to the third ray to eliminate gap. This illustration depicts 1 of 2 techniques that have been described regarding central ray. Single ray amputation in traumatic injury of the hand. Osteomyelitis in the diabetic foot first and second ray. Prosthetics for transhumeral amputations commonly consist of a prosthetic elbow joint in addition to a socket at the wrist and terminal devices hand that attaches to the socket. Fortyfive patients who underwent ray amputation were evaluated, 37 males and eight females whose mean age was 36. Amputation causes, types of amputation and amputation.
The finger is absent, imaged separately showing no further fracture of the phalanges. Digital ray amputation is not a commonly performed procedure. Amputation should only be considered if the limb is nonviable gangrenous or grossly ischemic, dangerous, malignancy or infection, or nonfunctional 1. Upper extremity amputations portnotes orthopaedicsone. Ring avulsion are relatively common hand lesions and are associated with significant disability, especially in hand workers. An amputation is the removal, by accident or by surgery, of a body part. The indications for amputation include gangrene, severe soft tissue infection, arterial occlusion, extensive osteomyelistis andor a nonhealing ulcer. Amputation is the cutting off or the removal of limbextremity or part thereof.
The technique of middle ray amputation used is essen tially that described in tandard texts of hand surgery, except that the metacarpal is not transected across. The indications for ray resection are ischemic necrosis involving the metacarpal, severe dysfunction of the proximal interphalangeal joint pipj and amputations at. Surgical proceduresamputation wikibooks, open books for. Pdf single ray amputation for tumors of the hand researchgate. Our observations suggest double ray amputation is an acceptable hand preserving procedure. Hypermobility of the first ray is a destructive process caused by compensatory subtalar and midtarsal joint pronation due to compensation for inherent phylogenic and ontogenicallyinduced characteristics and structural imperfections table 5, figure 6. I have a patient on whom i performed a 5th ray amputation for osteomyelitis and a soft. A sterile dressing of xeroform and two gauze was then applied which was tied around the wrist and then this was covered with coban. Third and fourth metacarpal heads stabilize the metacarpal arch by providing attachments for the. I cut off my own arm to save my life pleasure and pain with michael mosley bbc duration. The fifth finger is obliquely amputated through the proximal shaft of the proximal phalanx. Key words metacarpal ray resection, ray amputation hand, middle ray amputation, suture. The recoveries can vary, but light use of the hand is almost immediate.
Forequarter amputation for highgrade malignant tumours of the shoulder girdle. Functional and cosmetic outcome of singledigit ray. Complete fifth ray amputation with peroneal tendon. Ray amputation of the great toe leads to unstable weight bearing and some difficulty with ambulation resulting from loss of the first metatarsal head. Transmetatarsal amputation may be preferable to isolated first ray amputation in selected patients because transmetatarsal amputation has better healing rates and, owing to improved foot mechanics, better rehabilitation rates. Aug 15, 2017 middle or ring finger ray amputations absence in either finger makes a hole through which small objects can pass when the hand is used as a cup or in a scooping maneuver makes the remaining fingers tend to deviate toward the midline of the hand. Osteomyelitis is an infection which involves the bone marrow, surrounding cortical bone, and the periosteum. Single ray amputation after hand trauma or infection can result in good aesthetic and functional outcomes. A stepbystep approach for clinical evaluation and definitive management author. Single ray amputation is an ablative and reconstructive surgical technique that has good oncologic functional and aesthetic outcomes. Functional preservation when the amputation is at metacarpal. Nine articles met our including criteria and were analysed.
Amputation technique for a phalanx or a finger thierry dubert. Preoperative studies are necessary to plan the resection and reconstruction. They are sameday surgeries with the patient going home with a bulky soft dressing. The extents of toe and ray amputations for distal resections, a circular incision is made at the midpoint of the proximal phalanx, and the phalanx is resected at about its midpoint. Ray amputation is a good option in failure or no possible replantation, or in cases of useless finger or stump. Upon arrival, the cadaver was observed for any signs of surgery, skin ulcerations, or abnormality. Congenital deformities of the upper extremity months and 1 year of age. A novel approach to ray resection of the hand journal of hand. The role of this procedure in the management of aggressive benign or malignant hand tumors has been described only in case reports and small case series. Lower limb amputations can be divided into two broad categories. Immediate, early and late postsurgical management of upper limb amputation. Both bone and soft tissue contribute to the structure and function of the foot. Twenty patients 14 males, six females were assessed at an average of 32 months ten to 156 months after ray amputation using the disability shoulder, arm, hand dash questionnaire, physical examination and functional testing.
Single ray amputation for tumors of the hand article pdf available in clinical orthopaedics and related research 4685. Surgical proceduresamputation wikibooks, open books for an. In some cases an amputation is carried out on individuals as a preventative surgery. Major amputations are commonly belowknee or aboveknee amputations common partial foot amputations include the chopart, lisfranc, and ray amputations common forms of ankle disarticulations include pyrogoff. Bhagia sm, elek em, grimer rj, carter sr, tillman rm. Did an amputation of the bone in the finger happen. A novel approach to ray resection of the hand sciencedirect. A websaving skin incision for amputation of the third or. Therefore when faced with situations of hand loss, every attempt should be made to preserve as much length and function as possible.
For patients requiring complete fifth ray amputation, 620 30% patients had preoperative ulcerations located at the fifth metatarsal head, 320 15% had ulcers at the base of the fifth metatarsal, 120 5% patient had ulcerations located at the metatarsal base and head, and 1020 50% patients had previous. Triple central ray amputation for clear cell sarcoma of the. The aim of this study was to evaluate the functional and aesthetic results of the fifth ray radial translation and intercarpal arthrodesis in mutilating ring finger injuries. More than 90% involve the fingertip pulp, fingernail, andor distal phalanx only. Ray resections 5 techniques pearls and pitfalls indications a careful and complete history and physical examination are essential. Every care should be taken to assure that the amputation is done only when clinically indicated. In patients undergoing ray amputation for a painful stump, the point of maximal tenderness due to a neuroma if any should be identified preoperatively and marked. Amputation is a blind and final method in surgery to save the patients life. As far as the procedure coding, had you performed both an incision and drainage and debridement in the same wound site, only one proce. Major amputations are commonly belowknee or aboveknee amputations common partial foot amputations include the chopart, lisfranc, and ray amputations. However, when performed correctly it can dramatically improve hand function and cosmesis. Oct 02, 2019 amputations of the upper extremity largely follow the same basic principles as those of any amputated limb, some of which are covered in this article. Amputation is the removal of a body extremity by trauma or surgery.