Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.
  Table of Contents / Chapter 43:
Aesthetic Prostheses
  "Aesthetics is already function."

Aesthetic Importance of the Hand

In our technical civilization, in which the tool or the machine has largely replaced the hand for manual work, and in which appearance is the prime evidence of a person's value, how can one overcome the complex of abnormality, the complex of amputation? Only an aesthetic prosthesis can mitigate this complex, and sometimes make it disappear, by restoring a normal appearance to a deformed hand.1

Candidates for the Aesthetic Prosthesis

To simplify this chapter, only unilateral, distal amputees will be considered. Our experience has shown two groups of amputees, congenital and acquired.


The aesthetic concern of congenital amputees springs from comparison with others, and by people's insistent stares. These amputees are eager to go through life unnoticed, not to be identified because of their handicap. These patients virtually never ask spontaneously for functional help. For the young congenital amputee, surgical or prosthetic help is often asked by his parents or the family's physician, who knows of the new reconstructive surgical possibilities.


When confronted with these patients, we think of them wrongly, not as "amputees" but as having a "congenital deformity." We make this mistake when, in an effort to understand what it is like to be in their shoes, we mentally amputate ourselves.

The congenital amputee leads a normal life; he merely uses different techniques from ours. He is disabled only in the eyes of other people (see Fig. 43-1). Though he proves himself to be functionally normal, he suffers from not looking like everybody else and develops the same aesthetic concern as the acquired amputee.2


The acquired amputee goes through two periods: the recent amputation, which is familiar to the surgeon, and the old or "fixed" amputation, which is not well known.


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