|Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.|
The ideal stump should be painless, well vascularized, free of tropic troubles, well filled out, and well oriented. Above all, it should have sensation.
The requirements of the prosthesis are different and diversified, but must attain natural aesthetics to reproduce the shape, imitate skin details, and give a faithful imitation of skin color. It should have inlaid fingernails that can be polished. The material must be a soft one that will not harden or warp and will be nonirritating and nonallergenic. It must be easy to repair if torn, have stable coloring, not soil easily, and be washable. These qualities, which were never attained with polyvinyl chloride, have been attained with the silicones.
Types of Prostheses According to the Level of Amputation
The fingernail prosthesis, although easy to make, is difficult to fix. Fixation by glue is hard to manipulate. It has to be refixed every 2 to 3 days.
In surgical fixation, the fingernail is put in a furrow made by a dermoepidermoplasty. This technique seems excellent, but the bottom of the furrow rapidly fills up. The edge disappears, and the nail becomes loose and is no longer fixed in place.
Fixation by finger-stall (thimble type) covers the distal phalanx and is excellent.
Long stump. At the third phalanx level, the stump must be as short as possible to fix the prosthesis with an inlaid nail. If the amputation is proximal, the stump is often too large and spatulated, and may need surgical revision. The same is true for the proximal amputation of the second phalanx. The thimble-shaped prosthesis ends in a thin transparent edge before the PIP. Fixation is simple, secure, and effective. The prosthesis cannot fall off. To take it off, it is necessary to pinch the edge and allow air to enter.
Short stump. To be fittable, the stump must be 1.5 cm long from the top to the palmar fold. It must be well fitted by bone, cylindric in shape, and above all, not conical, to facilitate fixation of the prosthesis.
Toe transfer. Sometimes the patient requests a coverup aesthetic prosthesis "to go out on Sundays" (see Figs. 43-12, 43-13).
METACARPAL HAND AMPUTATION
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