Upper-extremity amputation surgery and prosthetic prescription.

Inasmuch as a number of persons with amputations in the so-called undesirable areas have been successfully fitted with appliances developed in recent years, it is our contention that the concept of "sites of election" in upper-extremity amputations is obsolete. Amputation surgery of the upper extremity should be directed toward saving all possible length in all areas. Prosthetic considerations need not dictate the amputation site. Physical aspects, such as skin coverage, adequacy of circulation, good innervation, and function of the part to be saved, should be the determining factors in the decision as to the level of amputation. Familiarity with the latest techniques of prosthetic manufacture and fitting are as essential for the surgeon as his knowledge of surgical techniques. Realization of the potentialities and limitations of recently developed prosthetic appurtenances are necessary for the prescription of the appliance best suited to the needs of the individual. Functional prosthetic replacements are available for almost all types of upper-extremity amputations10 {Fig. 15}. Prescription of the prosthesis which is best suited to the individual requirements of the patient is the privilege of the surgeon. This cannot be delegated. The surgeon should share the responsibility for amputee rehabilitation with the other members of the prosthetic team (the patient, therapist, trainer, prosthetist, job counselor, and psychologist), but he must remain captain. His responsibility to the patient does not terminate with wound healing. It continues through the period of rehabilitation. He must, with cooperation from other team members, supervise the readjustment of the patient to his handicap and direct the restoration of the patient to social and economic independence.