WHY AND HOW NERVE STUMP IN TRAUMATIC DIGITAL AMPUTATION SHOULD BE TREATED

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Traumatic Digital Amputation Replant or Repair Stump?Associated life-threatening injuryAgeOccupationDominance of the injured handCondition of the nerveSevere contamination of the injured partSegmental injury

• Kim SE, Chung KC. Replantation. In: Chung KC, editor. Hand and wrist surgery: operative techniques. Saunders: Philadelphia, 2008.p. 825-34

Repair Stump

Goals:MobileStableUseful

Painless

• Wilhelmi BJ, Weiner EL. Digital amputations. Available from http://www.emedicine.com/orthopaedics/18768245.htm. Cited on April 7th, 2009.

Painful amputation stump Neuropathic pain:

Inflammation

neuroma Bony prominences Contracture

Lewin-Kowalik J, Marcol W, Kotulska K, Mandera M, Klimczak A. Prevention and management of painful neuroma. Neurol Med Chir 2006; 46:62-8

Calandrugccio JH. Amputations of the hand. In: Canale ST, ed. Campbell ‘s Operative Orthopaedics , 11 th Ed. Mosby:Pensylvania 2008.p.639-74

Neuroma

Bulb-shape thickening created by improperly and irregulary regenerating nerve

Enhanced by mechanical stimulation, for example, the constantly rebuilt scar at the injury site

Wilhelmi BJ, Weiner EL. Digital amputations. Available from http://www.emedicine.com/orthopaedics/18768245.htm. Cited on April 7th, 2009. Calandrugccio JH. Amputations of the hand. In: Canale ST, ed. Campbell ‘s

Operative Orthopaedics , 11th Ed. Mosby:Pensylvania 2008.p.639-74

Neuroma prevention Many Ideas Limited evidence None has been accepted as the standard Some recommendations:

laser or scissors transection methodscapping of nerve stumptraction neurectomy

Lewin-Kowalik J, Marcol W, Kotulska K, Mandera M, Klimczak A. Prevention and management of painful neuroma. Neurol Med Chir 2006; 46:62-8

Traction neurectomy Principle:

Nerve end in a position away from the stump endAnticipated point-of-contact pressure

Performed bilaterally for each digital amputation Longitudinally distract in the distal direction then

transect allow proximal retraction Resec at least 6 mm proximal

Calandrugccio JH. Amputations of the hand. In: Canale ST, ed. Campbell ‘s Operative Orthopaedics , 11th Ed. Mosby:Pensylvania 2008.p.639-74

Wilhelmi BJ, Weiner EL. Digital amputations. Available from http://www.emedicine.com/orthopaedics/18768245.htm. Cited on April 7th, 2009.

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