Complex cases are so different that a prosthesis must be especially designed for each patient.

When there are no remaining digits, the metacarpal hand may be compared with a carpal amputation when fitting a prosthesis. The metacarpals are too short to activate the fingers of the prosthesis.

TOTAL AMPUTATION

The top of the stump must be put at the level of the base of the palm of the prosthesis because it is necessary to preserve sensitivity to the stump and its role of support.

How the Aesthetic Prosthesis is Worn

The majority of our patients can be divided into two groups: the patient who wears the prosthesis from morning to night as part of himself, and the patient who considers the prosthesis a garment, worn everyday, but not at home.

The minority can be divided into three groups. Some young women wear the prosthesis day and night. Some amputees wear it just once or twice a year for important events such as weddings and christenings. There are also a few patients who never wear their prostheses, but refuse to discard it because they have it if they should need it. They consider the prosthesis a "medicine."4

Conclusion

The psychologic difficulties met by acquired as well as congenital amputees are emphasized by a real socioeconomic handicap peculiar to our times. This handicap may be diminished or even removed by the aesthetic prosthesis. It is a real psychologic treatment and brings functional help through the motivation of the patient. It is worn if the patient needs it and discarded if the patient feels cured.

The hand surgeon, who has at his disposal a large range of techniques for the improvement of function and sensitivity, must also know the possibilities of aesthetic prostheses. They can be complementary to his treatment.

FIG. 43-01. The congenital amputee leads his life without facing any major handicap. The amputee is disabled only in other people's eyes and can perform routine tasks.

FIG. 43-02. Another example.

FIG. 43-03. Sometimes a surgically obtained pinch is considered as too repulsive to be used in public.

FIG. 43-04. Lengthening of the metacarpals covered by the prosthesis.

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