Unfortunately, amputation of a portion of the finger or hand is not an infrequent occurrence. Most often this occurs in an industrial setting, or during the use of home workshop or lawn equipment. Expert care of these injuries is absolutely critical to ensuring the best possible recovery. Regrettably, it is often only after such an injury that our patients recognize how crucial their hands are for their daily functioning and work!
Amputations can range from involvement of a small tip of a single finger, to multiple finger amputations, whole hand amputations or arm amputations. The focus of treatment of small tip amputations is usually to reconstruct the tip of the finger to give a good rounded contour of the fingertip, preserve the fingernail when possible, and provide the best sensation (feeling) in the fingertip without pain or discomfort. Most often this is done with the use of small skin flaps. Skin flaps involve techniques of transferring skin and soft tissue from one place in the body to another; in this case, to cover the fingertip. Many different kinds of flaps are possible, and the one best suited to a particular injury can best be determined by experience.
When all or a major part of a finger, or multiple fingers, or a hand has been amputated, the focus of treatment is often on reattachment of the amputated part. This must be done by a qualified team headed by a hand surgeon. This is extremely technically demanding surgery which can take many hours. Every structure must be reconnected: bones, tendons, nerves, muscle, arteries and veins. In the case of the fingers, the arteries, veins and nerves are often less than 1 mm. in diameter. Such surgery must be done under a microscope with specialized instruments, sutures and techniques. These techniques have been developed and improved over the last 30 years, but are still only routinely available at specialized centers for hand surgery such as Virginia Hand Center.
The patient with an amputation who undergoes reattachment of the body part (“replantation”) undergoes a major commitment. He or she has suffered a devastating injury. Every focus of treatment for these patients must be on successful surgery, followed by a lengthy guided rehabilitation program. Patients must be committed to their rehabilitation, as it may often last up to one year or more. However, successful replantation, with return to function, is one of the most gratifying procedures we do. We have many patients who rely on their hands for their living: cabinetmakers, trim carpenters, factory workers, mechanics — whose lives have been changed forever by a major traumatic hand injury, but who have successfully re-entered the work place, often doing the same or similar jobs that they did before injury. Many of these patients have become life long “friends” of Virginia Hand Center.
As an aside, for those patients who suffer amputation and smoke cigarettes, it is essential that they stop smoking for the reattachment to be successful. The single most critical factor for success in replantation is re-establishment of the blood supply to the reattached part. Smoking decreases the blood supply to the fingers through multiple mechanisms, and for those who continue to smoke cigarettes, the chance of success of the surgery is dramatically decreased.