Surgery of hand and finger amputations.

The management of upper limb amputations is an important part of the practice of surgery of the hand. Reattachment of parts has opened dramatic new potentials, but elective amputation and wound closure after traumatic loss remain frequent and important operations. The negative aura surrounding these unpleasant events favors their quick disposition, but they demand the same measured judgement, technical skill, and concern that any reparative hand operation requires. Many basic surgical principles related to amputation are well established and must be followed. The difference in surgery under war conditions and civilian practice, where careful surveillance is possible, must be appreciated. Secondary procedures must be proposed on the basis of very careful study of the circumstances and the needs of each patient, above all avoiding unrealistic attempts at reconstruction. The aesthetics and the psychological impact cannot be ignored. Success can be measured only by the patient's recovery in a global sense, that is, how well he or she resumes normal life.