title: Traumatic and trauma-related amputations: Part II: Upper extremity and future directions.
abstract: Trauma is the most common reason for amputation of the upper extremity. The morphologic and functional distinctions between the upper and lower extremities render the surgical techniques and decision-making different in many key respects. Acceptance of the prosthesis and the outcomes are improved by performing a transradial rather than a more proximal amputation. Substantial efforts, including free tissue transfers when necessary, should be made to salvage the elbow. Careful management of the peripheral nerves is critical to minimize painful neuroma formation while preserving options for possible future utilization in targeted muscle reinnervation and use of a myoelectric prosthesis. Rapid developments with targeted muscle reinnervation, myoelectric prostheses, and composite tissue allotransplantation may dramatically alter surgical treatment algorithms in the near future for patients with severe upper-extremity trauma.
authors.affiliation: Orthopaedic Surgery Service, Integrated Department of Orthopaedics and Rehabilitation, Walter Reed Army Medical Center, 6900 Georgia Avenue N.W., Building 2, Clinic 5A, Washington, DC 20307, USA.
authors.forename: Scott M
authors.initials: SM
authors.lastname: Tintle
authors.forename: Martin F
authors.initials: MF
authors.lastname: Baechler
authors.forename: George P
authors.initials: GP
authors.lastname: Nanos
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Forsberg
authors.forename: Benjamin K
authors.initials: BK
authors.lastname: Potter
mesh_terms: D000671:Amputation, Surgical / Q000379:methods*; D000672:Amputation Stumps; D000673:Amputation, Traumatic / Q000175:diagnosis / Q000601:surgery*; D001134:Arm Injuries / Q000175:diagnosis / Q000601:surgery*; D001186:Artificial Limbs; D005260:Female; D005500:Follow-Up Studies; D006230:Hand Injuries / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D015601:Injury Severity Score; D023821:Limb Salvage / Q000379:methods*; D008297:Male; D008866:Microsurgery / Q000379:methods; D011474:Prosthesis Design; D017755:Prosthesis Fitting; D011788:Quality of Life; D012092:Replantation / Q000379:methods; D018570:Risk Assessment; D016896:Treatment Outcome