Upper limb amputations and prostheses.

The management of amputations is an important area of surgery of the hand and demands the same measured judgment, global perspective, and technical skill of any other reconstructive procedure. The needs of each patient are different, even when physical losses are similar. In terms of physical impairment, the bilateral hand amputee is a totally different problem than the unilateral. Logical choice requires knowledge of and consideration of all the alternatives, including prosthetic fitting potentials. As surgical procedures often are irreversible, it is important that the best master plan be devised as early as possible. Major reconstructions for the partially amputated hand and prosthetic fitting usually have a remarkably common physical goal--restoration of a simple vise mechanism. Today, this goal must include restoration of a socially acceptable presentation of the constantly exposed hands. To many patients in our mobile and competitive society, the latter will be their greater need. Both active and passive prosthetic devices are functional; they simply meet different needs and each has advantages and disadvantages. The usefulness of motorized units for unilateral amputees remains severely limited as all such devices are "second-thought" mechanisms having no sensory feedback, an indispensable requirement for automatic control. Hand prostheses are playing an increasingly important role in the treatment of amputees. The surgeon charged with primary responsibility of care must be knowledgeable about them. With the rapid changes in our work force and the ever-increasing mobility of our society, it is unrealistic to ignore or deny that a grotesque or badly deformed hand is a serious socioeconomic liability. The needs of each patient are different, but the prosthetic needs of most patients in the future will include mechanically simple devices of socially acceptable appearance.