Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.
  Table of Contents / Chapter 43:
Aesthetic Prostheses
  The recent amputee goes through two phases. The first is one of emotional shock when he hears that his limb has been sacrificed because of the extent of his injuries. This is the incubus. Everything "collapses." The amputee, however, is in the hospital; he has his bandages; he is being taken care of; and he feels protected and understood. He finds it normal to be helped in his everyday life while waiting for impending healing. The second phase comes after he leaves the hospital and is back in his family circle again. This is the period of disability, a time of adaptation and rehabilitation of the remaining hand. He draws on all his strength to attain autonomy. This is when the family, the physician, and prosthetic attempts play an important role.


Once his behavior has stabilized, the amputee may fall into one of the following two groups, the disabled and the compensated.

The disabled are the minority. They have not coped with their handicap and have never achieved psychologic conversion. Some never cope with their amputation; others do so only partially, becoming dependent on an economically strong and socially evolved environment.3

The compensated are the majority. They have achieved social and effective rehabilitation. Factors that play an important role in the achievement are the level of amputation and the age of the patient. The more distal the amputation, the less the disability. Better function is obtained if the stump is in perfect condition and is painless. The younger the patient

  is at the time of amputation, the more rapid is his rehabilitation. In a great majority of cases, the acquired amputee copes with his handicap in the long run. Its importance diminishes, and finally he forgets about his lost function. The sound hand acquires much more ability and is helped by the sensitive stump. For a long time, however, and sometimes permanently, the feeling of aesthetic frustration remains in his mind. This is when we can compare congenital and acquired amputees.

Indications for Prostheses


Should patients be systematically fitted for a prosthesis on demand? The prosthetic consultation is important. The doctor has to decide if the patient is a good candidate for an aesthetic prosthesis, according to prosthetic criteria. The patient should be highly motivated by the appearance of his hand and have realistic expectations. The patient's real motivation is not always easy to detect because unrealistic and illusory enthusiasm may be behind an insistent demand. Sometimes the demand comes from the parents, the family circle, friends, and doctors, while the patient is not yet concerned with aesthetics.


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