WHAT YOU SHOULD KNOW
Major trauma to the upper extremity may result in amputation or such extensive damage that amputation appears to be the only option. To save the body part whether it is one finger, the hand, or the whole arm requires complex microsurgery. First and foremost the body part must have blood supply coming in and going out. Nerves must connect to the organs for movement and feeling. The skin layer covering all the other tissues must be stable, durable, and healthy. The bone and joints that provide structure to the limb must be stable and mobile. The tendon systems that move the body part must connect and glide back and forth. If all of these goals cannot be met, it is usually not the right answer to preserve the body part.
MEDICAL HISTORY
As much information as possible about how the injury occurred will help the surgeon understand the pattern of damage to the various tissues. This is important for planning the reconstruction.
EXAMINATION
Each of the damaged tissues must be carefully examined for the extent of injury. Only when this information is known can the surgeon even determine if a reconstruction is possible or advisable. Although this examination begins in the emergency department, it can only be completed during surgery.
ADDITIONAL TESTS
Plain x-rays are used to reveal the pattern of bone and joint damage.
TREATMENT OPTIONS
| AMPUTATION | MICROSURGICAL LIMB RECONSTRUCTION | |
| CONSISTS OF | Forming the best possible residual limb at the level of damage | Rebuilding the damaged limb with tissues taken from elsewhere in the body |
| FEATURES | Usually completed on the day of injury with one surgery only | May involve a series of surgeries and prolonged stay in the hospital |
| ADVANTAGES | Fastest recovery period for patient | Preserves body part |
| DISADVANTAGES | Lost body part | Final function will not be normal, recovery may be prolonged |
RECOVERY
After amputation surgery the patient is usually discharged quickly from the hospital into outpatient rehabilitation. When the wounds heal in several weeks, the limb is trained for use again. If the amputation was at a major level in the arm, prosthetic fitting begins when swelling is gone and the skin layers are stabilized.
If microsurgical reconstruction is performed, the patient usually remains in the hospital on intravenous anticoagulants for around a week. Outpatient rehabilitation exercises for motion are started the week after discharge and continue for many months thereafter. Often, follow-up surgeries for tendon transfers or contracture releases are required. The total time before the patient has graduated the reconstructive process will be measured in months rather than weeks.
