Amputation and Prosthetics

What is amputation?

Amputation is the complete removal of an injured or deformed body part. Amputation may occur during a traumatic injury, or may be performed by a surgeon for medical reasons, for example, because of the presence of a tumor. Some traumatically amputated body parts can be replanted or reattached, but in some cases, reattachment of the amputated finger is not possible or advisable. Mass General’s Hand & Arm Service specializes in the surgical amputation of injured or deformed arms, hands and fingers, as well as the reattachment of traumatically amputated limbs when possible.

How is an amputation done?

When an amputation is necessary, the surgeon removes the injured or deformed body part and prepares the amputation site and any remaining section for future prosthetic adaptation. This means careful treatment of the skin, muscles, tendons, bones and nerves, so that a prosthesis can be worn comfortably. The surgeon determines how much of the body part will remain based on medical and prosthetic factors.

Expectations after surgery

For the first couple of weeks, you should expect some pain, which is controlled with pain medications. While you are healing, your doctor will tell you how to bandage and care for the surgical site and when to return to the office for follow-up care. You may be given exercises to build your strength and range of motion. You may be asked to touch and move your skin to desensitize it and to keep it mobile.

Prosthetics

What type of prosthetic will I get?

The type of prosthetic limb, or prosthesis, a patient adopts depends on the amputation location, size of remaining body part, and your functional and lifestyle needs. The prosthesis replaces some of the function and the appearance of the missing body part. It is important to communicate to your doctor and prosthetist the activities you feel are most important, so that an appropriate prosthesis can be provided for you. Prostheses can restore length to a partially amputated finger, enable opposition between the thumb and a finger, or in the case of a prosthetic hand, stabilize and hold objects with bendable fingers. If your hand is amputated through or above the wrist, you may be given a full arm prosthesis with an electric or mechanical hand. Some patients may decide not to use a prosthesis.

How is a prosthesis made?

A prosthesis is fabricated from an impression cast taken from the residual finger or limb and the corresponding  undamaged body part. Through this process, an exact match to the details of the original limb can be achieved. The prosthetic limb is fabricated out of a flexible, transparent silicone rubber. Colors dispersed in the silicone are carefully matched to the individual’s skin tones, which give the prosthesis the life-like look and texture of real skin. The limb is usually held on by suction. The flexibility of the silicone permits good range of motion of the remaining body parts. Fingernails can be individually colored before applying them to the fingers so they can be matched almost perfectly. The nails can be polished with any nail polish and the polish can be removed with a gentle-action nail polish remover. Silicones are resistant to staining. Inks wash off easily with alcohol or soap and warm water. With proper care, a silicone prosthesis may last 3-5 years. Prosthesis creation usually begins three months after the patient has completely healed from amputation surgery. This waiting period allows time for swelling to subside and for the remainder of the limb to take its final shape. Physical and occupational therapy can help with adaptation to the new prosthesis.

Common feelings following an amputation

The loss of a body part, especially one as visible as a finger, hand or arm, can be emotionally upsetting. It may take time to adapt to changes in physical appearance and ability to function. Talking about these feelings with a doctor, therapist, or other patients who have had amputations often helps patients come to terms with amputation. You may ask your doctor to recommend a counselor to assist with this process. It is important to remember that with time, patients adapt by finding new ways of doing daily activities. A resource that may help is the Amputee Coalition of America. Remember that the quality of life is directly related to one’s attitude and expectations – not just obtaining and using a prosthesis.

Used with permission from American Society for Surgery of the Hand.