Partial Hand Amputation Research Articles

Motion-mimicking Robotic Finger Prosthesis for Burn-induced Partial Hand Amputee: A Case Report.

Burn injuries often result in severe hand complications, including joint contractures and nerve damage, sometimes leading to amputation. Despite early treatment, hypertrophic scarring frequently hampers hand function recovery, and the thick raised scar blocks electromyography (EMG) sensing. A promising solution involves motion-mimicking robotic finger prostheses tailored to individual patient requirements. By utilizing the versatility of motion-capturing technology on a sound finger, a robotic finger prosthesis can mimic the movement of a sound finger simultaneously with less latency than EMG-based sensory mechanisms through hypertrophic scars. This case study evaluated the clinical efficacy of a customized three-dimensional printed robotic finger prosthesis in a 24-year-old man who sustained left second finger loss due to electrical burns. Despite undergoing reconstructive surgery, the patient struggled with manual dexterity. Following the adoption of a personalized robotic finger prosthesis with a finger motion-capturing device, significant improvements in grip strength and daily task performance were observed. This innovative approach has advantages such as customization, reduced latency time for finger movements, and affordability from low-cost manufacturing, suggesting its potential for broader adoption among burn-induced amputees.

Partial hand and finger amputations in Sweden: an observational study of 6918 patients

BackgroundWe aimed to use open source data to understand the incidence, trends, and regional differences of finger and partial hand amputations on a national level in individuals aged 15 or older in Sweden.MethodsWe analyzed 6,918 patients aged 15 and older who had experienced finger and partial hand amputations. Incidence rates, trends, and regional disparities were assessed using negative binomial regression models and Student’s t-tests. Future trend prediction was performed using Poisson regression.ResultsFinger amputations declined most, followed by partial hand and thumb amputations. Regional variations existed, with Stockholm having the lowest and Gotland highest incidence respectively. Overall, the incidence of finger, thumb and partial hand amputations in Sweden decreased slightly. Future trend analysis indicated decreasing incidence.ConclusionAlthough, lacking in definition, publicly available data can be used for monitoring of finger, thumb, and partial hand amputation incidence on a national level. Sex, age, and regional differences were observed, suggesting the need for targeted interventions to address disparities and mitigate the burden of finger and partial hand amputations on affected individuals.

Frequency of patients presenting with Hand Infection and treatment modalities

Introduction: Infections of the hand are one of the most common infections reported by the caring physicians and surgeons. Common types of hand infections include: bite wounds, felon, necrotizing fasciitis, paronychia, flexor tenosynovitis, subcutaneous/cellulitis, osteomyelitis and septic arthritis. Aims: The aim of this study to identify the main etiological factors, possible complications due to acute hand infection and treatment modalities performed in our selected group of patients. Materials and Method: This was a prospective Cross Sectional Observational Study based on 58 patients conducted at King Abdullah Hospital, Bisha, Saudi Arabia. Period of study was one year from May 2022 to April 2023. Patients of all age group were included. Male patients were 16 (27.5%) while females were 42 (72.4%). Result: Most of the patients were gardener / farmer 15 (25.9%), minor children 12 (20.7%), and housewife / maid 9 (15.5%). Major mechanism of injury was penetrating trauma 41 (70.7%). Majority of the patients were between 20 years to 50 years of age group. The risk factors associated with hand infection includes diabetes mellitus 13 (22.4%) and hypertension 5 (8.6%). The smokers were 13 (22.4%) patients. Most of the patients were Saudi national 30 (51.7%) followed by Egyptian12 (20.7%), Pakistani and Sudanese 4 (6.9% each). Surgical intervention includes, incision and drainage in 40 (68.9%) cases while amputation was performed in 3 (5.2%) cases. There were 15 (25.9%) patients treated with conservative treatment protocol. Major organisms causing infection was staphylococcus aureus 28 (48.30%) including methicillin resistant staphylococcus aureus (MRSA). There was no growth in 5 (8.6%) patients and for 19 (32.8%) patients no drainage collection was available and therefore their samples were not analyzed for bacteriology. We have categorized the diagnosis into 6 groups as subcutaneous infection 27 (41.5%), acute Paronychia 11 (16.9%), web space infection 10 (15.4%), pulp space infection7 (10.8%), flexor tenosynovitis 6 (9.2%) and midpalmer/thenar 4 (6.2%). Conclusion: Early clinical diagnosis based on occupational history and control of co-morbid disease such as diabetes mellites, smoking etc is effective in the treatment and prevention of hand infection to avoid devastating surgical intervention of partial or total diabetic hand amputation.

Restoring natural upper limb movement through a wrist prosthetic module for partial hand amputees

BackgroundMost partial hand amputees experience limited wrist movement. The limited rotational wrist movement deteriorates natural upper limb system related to hand use and the usability of the prosthetic hand, which may cause secondary damage to the musculoskeletal system due to overuse of the upper limb affected by repetitive compensatory movement patterns. Nevertheless, partial hand prosthetics, in common, have only been proposed without rotational wrist movement because patients have various hand shapes, and a prosthetic hand should be attached to a narrow space.MethodsWe hypothesized that partial hand amputees, when using a prosthetic hand with a wrist rotation module, would achieve natural upper limb movement muscle synergy and motion analysis comparable to a control group. To validate the proposed prototype design with the wrist rotation module and verify our hypothesis, we compared a control group with partial hand amputees wearing hand prostheses, both with and without the wrist rotation module prototype. The study contained muscle synergy analysis through non-negative matrix factorization (NMF) using surface electromyography (sEMG) and motion analyses employing a motion capture system during the reach-to-grasp task. Additionally, we assessed the usability of the prototype design for partial hand amputees using the Jebsen-Taylor hand function test (JHFT).ResultsThe results showed that the number of muscle synergies identified through NMF remained consistent at 3 for both the control group and amputees using a hand prosthesis with a wrist rotation module. In the motion analysis, a statistically significant difference was observed between the control group and the prosthetic hand without the wrist rotation module, indicating the presence of compensatory movements when utilizing a prosthetic hand lacking this module. Furthermore, among the amputees, the JHFT demonstrated a greater improvement in total score when using the prosthetic hand equipped with a wrist rotation module compared to the prosthetic hand without this module.ConclusionIn conclusion, integrating a wrist rotation module in prosthetic hand designs for partial hand amputees restores natural upper limb movement patterns, reduces compensatory movements, and prevent the secondary musculoskeletal. This highlights the importance of this module in enhancing overall functionality and quality of life.

Case Report: Rehabilitation of bilateral below-knee and partial-hand amputations in a developing country

Limb ischemia is a complication of peripheral artery disease (PAD)which can lead to amputation. Amputation occurs in approximately 3-4% of PAD patients. In Indonesia, post-amputation patients are only hospitalized for the acute phase and the post-amputation rehabilitation programs must be done as an outpatient. This could be a barrier to the continuity of rehabilitation programs. A solution is the application of home-based rehabilitation programs. A 57-year-old female was referred from the Cardiothoracic Surgery Outpatient Clinic post-amputation with bilateral below-knees and partial-hands amputation after being diagnosed with PAD. On initial examination, all her elbows, wrists, thumbs, hips, and knees showed weakness. The patient received neuromuscular electrical stimulations (NMES) as well as a home-based rehabilitation programs. On the second examination, after considering the data from the clinical finding and supporting examination, the patient received bilateral below-knee prostheses and bilateral functional partial-hand prostheses, created using 3D printing technology with polylactic acid material. After a few months, she was able to do most of her activities of daily living (ADLs) independently, work as a shopkeeper in her store, and feel more confident interacting with others. A comprehensive rehabilitation programs, patient adherence to exercise, and caregiver support are critical to improving functional capacity and the quality of life in a patient with bilateral below-knee and bilateral partial-hand amputation caused by PAD.

From iron hooks to moving hands: The evolution of partial hand prostheses—a surgical perspective

Partial hand amputations have profound effects on individuals and are frequently associated with stigma, disability, and perceptions of inadequacy. When reconstructive measures inadequately restore hand form and function, partial hand prostheses may greatly improve independence and identity. Historically, partial hand prostheses were limited to iron hooks and hands, which were largely assistive rather than restorative. However, since the close of World War II, technological advances have dramatically increased the versatility and availability of prosthetic options. Mirroring the rise in prosthetic options, numerous surgical strategies to reconstruct the residuum and facilitate successful prosthetic fittings have been established in recent decades. To assist hand surgeons caring for partial hand amputees, this article provides a historical background of partial hand prostheses, describes the current prosthetic classes, and highlights key techniques that ease device fittings and improve overall hand function with a prosthesis. These orthoplastic concepts, coupled with multidisciplinary collaboration, will likely improve patient outcomes and provide life-restoring solutions for partial hand amputees.

The Starfish Procedure for Independent Digital Control of a Myoelectric Prosthesis.

Management of partial hand amputations is a notable clinical challenge. Historically, myoelectric prostheses have not allowed for independent digital control, resulting in unsatisfactory function and high rejection rates among upper extremity amputees. The Starfish Procedure was developed for patients who sustained loss of multiple digits through the level of the base of the proximal phalanx or distal metacarpal. The procedure involves the pedicled transfer of 1 or more dorsal interosseous muscles to a subcutaneous location. This allows for a myoelectric sensor to capture the signals generated by these transferred muscles, thereby enabling intuitive, independent, digital prosthetic flexion and extension. In this article, we detail the relevant anatomy, indications, and technique for performing the Starfish Procedure. Given our patients' promising outcomes to date, we hope this technique paper will encourage upper extremity surgeons of all training backgrounds to perform this relatively straightforward procedure, thereby allowing patients with life-altering finger amputations to regain meaningful function by enhancing control of digital prostheses.

Case Report: Rehabilitation of bilateral below-knee and partial-hand amputations in a developing country

Limb ischemia is a complication of peripheral artery disease (PAD)which can lead to amputation. Amputation occurs in approximately 3-4% of PAD patients. In Indonesia, post-amputation patients are only hospitalized for the acute phase and the post-amputation rehabilitation programs must be done as an outpatient. This could be a barrier to the continuity of rehabilitation programs. A solution is the application of home-based rehabilitation programs. A 57-year-old female was referred from the Cardiothoracic Surgery Outpatient Clinic post-amputation with bilateral below-knees and partial-hands amputation after being diagnosed with PAD. On initial examination, all her elbows, wrists, thumbs, hips, and knees showed weakness. The patient received neuromuscular electrical stimulations (NMES) as well as a home-based rehabilitation programs. On the second examination, after considering the data from the clinical finding and supporting examination, the patient received bilateral below-knee prostheses and bilateral functional partial-hand prostheses, created using 3D printing technology with polylactic acid material. After a few months, she was able to do most of her activities of daily living (ADLs) independently, work as a shopkeeper in her store, and feel more confident interacting with others. A comprehensive rehabilitation programs, patient adherence to exercise, and caregiver support are critical to improving functional capacity and the quality of life in a patient with bilateral below-knee and bilateral partial-hand amputation caused by PAD.

Prospective pre-operative 3-T MR neurography peripheral nerve mapping of upper extremity amputations implanted with FAST-LIFE electrode interfaces of robotic hands: technical report.

Fascicular targeting of longitudinal intrafascicular electrode (FAST-LIFE) interface enables hand dexterity with exogenous electrical microstimulation for sensory restoration, custom neural recording hardware, and deep learning-based artificial intelligence for motor intent decoding. The purpose of this technical report from a prospective pilot study was to illustrate magnetic resonance neurography (MRN) mapping of hand and nerve anatomy in amputees and incremental value of MRN over electrophysiology findings in pre-surgical planning of FAST-LIFE interface (robotic hand) patients. After obtaining informed consent, patients with upper extremity amputations underwent pre-operative 3-T MRN, X-rays, and electrophysiology. MRN findings were correlated with electrophysiology reports. Descriptive statistics were performed. Five patients of ages 21-59years exhibited 3/5 partial hand amputations, and 2/5 transradial amputations on X-rays. The median and ulnar nerve end bulb neuromas measured 10.1 ± 3.04mm (range: 5.5-14mm, median: 10.5mm) and 10.9 ± 7.64mm (2-22mm, 9.75mm), respectively. The ADC of median and ulnar nerves were increased at 1.64 ± 0.1 × 10-3 mm2/s (range: 1.5-1.8, median: 1.64 × 10-3 mm2/s) and 1.70 ± 0.17 × 10-3 mm2/s (1.49-1.98 × 10-3 mm2/s, 1.65 × 10-3 mm2/s), respectively. Other identified lesions were neuromas of superficial branch of the radial nerve and anterior interosseous nerve. On electrophysiology, 2/5 reports were unremarkable, 2/5 showed mixed motor-sensory neuropathies of median and ulnar nerves along with radial sensory neuropathy, and 1/5 showed sensory neuropathy of lateral cutaneous nerve of the forearm. All patients regained naturalistic sensations and motor control of digits. 3-T MRN allows excellent demonstration of forearm and hand nerve anatomy, altered diffusion characteristics, and their neuromas despite unremarkable electrophysiology for pre-surgical planning of the FAST-LIFE (robotic hand) interfaces.

Rehabilitation of Partial Hand Amputations in Pakistan

Objective: To describe prosthetic/cosmetic rehabilitation of partial hand amputations.
 Study Design: Case series.
 Place and Duration of Study: Out Patient Department (OPD) of the Rehabilitation Department Combined Military Hospital Multan from Jul to May 2020.
 Methodology: Patients with partial hand amputations, due to any cause, reporting to OPD of Rehabilitation Department in CMH Multan were included. Demographic data (age, gender, education), cause, type and duration of injury and cosmetic intervention were documented. 
 Results: A total of 10 patients were recruited. All the participants were males. The mean age of the patients was 34.1 ± 2.8 years. The average duration of amputation was 5.2 ± 1.7 years. The most common cause of amputation was blast injury (n=3), followed by injury with heavy machinery (n=2), firearm injury (n=2), fall from the train (n=1), electric injury by high tension wire (n=1), and frostbite (n=1). The type of amputation included: left transmetacarpal with thumb sparing (n=3), ray amputation of the right index finger (n=3), right transmetacarpal with thumb sparing (n=1), ray amputation of the right middle finger (n=1), amputation left partial thumb and index finger (n=1), the right fourth and fifth finger amputation (n=1). All the patients could carry out activities of daily living even without a prosthesis. Ottobock silicon finger fillers with cosmetic sleeves were provided to all the patients.
 Conclusion: Aesthetically acceptable silicon finger fillers are the mainstay of rehabilitation of hand amputations in lower-middle-income countries with poor access to rehabilitation.

The Patterns of Acquired Upper and Lower Extremity Amputation at a Tertiary Centre in Saudi Arabia.

Introduction: Upper and lower extremity amputations are associated with variable degrees of physical disability. In Saudi Arabia, disability still represents a major challenge for healthcare systems. There are insufficient data to describe the incidence and prevalence of impairment and disability. This study attempts to identify the patterns of limb amputations at a tertiary centre.Methods: A retrospective chart review of the data of patients who received integrated tertiary healthcare in an amputation rehabilitation program (ARP) from 2013 to 2018 at King Fahad Medical City, Riyadh, Saudi Arabia was conducted. Data were collected using the demographic data and clinical history of amputees.Results: A total of 412 patients were included in the study. Transtibial amputation (70%) and partial hand amputation (48%) were the most common levels for lower and upper limb amputations, respectively. There was a significantly higher rate of lower limb amputations secondary to vascular causes than that of upper limb amputations, which were more related to traumatic causes. Most patients, 213 (52%), were enrolled in an amputation rehabilitation program over a year after their amputation.Conclusion: Vascular amputation is the most common cause of amputation. Most patients entered the rehabilitation program over a year after amputation. National guidelines for the prevention and management of the risk factors for vascular amputations should be developed.

Current and emerging prostheses for partial hand amputation: A narrative review.

Partial hand amputation can have a tremendous range of impact and functional loss on a person's life. One solution to improve function and address some of the problems that partial hand amputees face is to fit them with a prosthesis. Partial hand prosthetic devices range in a wide spectrum in both function and aesthetics. At this time, there is no one, perfect prosthetic device that can replace what is lost. Many individuals with partial hand amputation require more than one prosthetic device. In this review article, we explored and compared several prosthetic options that have been investigated and marketed by researchers and companies. Some of these options include passive, body-powered, activity-specific, and externally-powered prostheses. Lastly, we described our experiences with partial hand prostheses at Walter Reed National Military Medical Center.

Digital Nerve Management and Neuroma Prevention in Hand Amputations.

Hand and digit amputations represent a relatively common injury affecting an active patient population. Neuroma formation following amputation at the level of the digital nerve can cause significant disability and lead to revision surgery. One method for managing digital nerves in primary and revision partial hand amputations is to perform interdigital end-to-end nerve coaptations to prevent neuroma formation. All patients with an amputation at the level of the common or proper digital nerves that had appropriate follow-up at our institution from 2010 to 2020 were included. Common or proper digital nerves were managed with either traction neurectomy or digital end-to-end neurorrhaphy. The primary outcome was the development of a neuroma. Secondary outcomes included revision surgery, complications, and visual analog pain scores. A total of 289 nerves in 54 patients underwent hand or digital amputation in the study period. Thirteen hands with 78 nerves (27%) underwent direct end-to-end coaptation with a postoperative neuroma incidence of 12.8% compared with 22.7% in the 211 nerves that did not have a coaptation performed. Significantly fewer patients reported persistent pain if an end-to-end coaptation was performed (0% vs. 11.8%, P < .01). The prevalence of depression and workers compensation status was significantly higher in in patients with symptomatic neuromas than in patients without symptomatic neuromas (P < .01). Digital nerve end-to-end neurorrhaphy is a method for neuroma prevention in partial hand amputations that results in decreased residual hand pain without increase complications. Depression and worker's compensations status were significantly associated with symptomatic neuroma formation.

Hand Surgeons' Understanding of Partial Hand Prostheses: Results of a National Survey Study.

Partial hand amputations are devastating injuries that often negatively affect individuals and communities. Partial hand prostheses can mitigate the burdens of living with an amputation, especially when reconstruction alone cannot restore form or function. However, hand surgeons may be unfamiliar with these newer devices because the prosthetic field is rapidly progressing. An electronic survey was distributed to hand surgeon members of the American Association for Hand Surgery with the intent of assessing surgeons' familiarity with partial hand prosthetic devices and their clinical applications. Survey items used Likert 5-point scales, rank order, multiple-choice, and yes/no question formats. Responses were compared by training background (orthopedic or plastic surgery) and by years of experience (≤10 years in practice or >10 years in practice). Overall, hand surgeons are unfamiliar with modern partial hand prosthetic devices. Most of the cohort denied working within a multidisciplinary hand team (76.2%) or consulting with a prosthetist prior to revisional surgeries (71.4%). Restoring gross motor function and reducing pain were important outcomes to the cohort (4.42 and 4.17, respectively). Plastic trained hand surgeons were more likely to list toe-to-hand transfers as treatment options for multilevel digital amputations (P = .03) and transmetacarpal amputations (P = .02). Senior hand surgeons were more likely to suggest no treatment for partial thumb amputations (P = .02). Expanding surgeon knowledge and encouraging collaboration within a multidisciplinary team may enhance amputee care.

The Starfish Procedure

Partial hand amputations are devastating injuries, which can significantly impact ability to work and activities of daily living. Prosthetics can improve function for amputees; however, prosthesis utilization rates have historically been low in this patient population. Prosthetics for partial hand amputees can be active, passive, or driven by myoelectric signals. Myoelectric prosthetics have a role in dramatically improving patient function, but intuitive control of these prosthetics has not been possible. Frustration with ability to control these prosthetics, and an inability to control individual digits contributes to low utilization rates for these patients. The Starfish procedure was developed to provide patients with an intuitive ability to control individual myoelectric digits on a partial hand prosthesis.

The Octopus Procedure Combined with Targeted Muscle Reinnervation for Elective Transhumeral Amputation.

Summary:Optimizing prosthetic function and tolerance are key principles of performing an elective upper extremity amputation. It is common for upper extremity amputees to experience issues related to nonoptimal prosthetic control and pain. Targeted muscle reinnervation and regenerative peripheral nerve interfaces in elective transhumeral amputations have been introduced as techniques to address the paucity of signals that may exist for myoelectric control postamputation. These techniques require the denervation of muscle and rely on delayed muscle reinnervation to provide eventual signal amplification for prosthetic function. In addition, the fascicles cannot be separated enough to provide signals to each individual muscle. Use of native innervated forearm musculature can provide more immediate and specific signals for prosthetic use. These native muscles are often not available for use due to trauma, denervation, or dysvascularization. In elective amputations, they can be used as spare parts to provide more signals for the sensors on a myoelectric prosthetic. The concept has been used in partial hand amputations and allowed for individual digital control at the terminal prosthetic device. In this study, we describe a novel technique used for an elective transhumeral amputation utilizing native innervated, vascularized musculature to provide intuitive control of a myoelectric prosthetic.

An exploratory study of the impact of firecracker-induced hand injuries on adolescents and their parents

BackgroundSevere hand injuries due to firecrackers are unfortunately common in the Netherlands. These injuries are expected to have long-term functional and psychological sequalae. We performed a study to assess the long-term impact of such injuries on the victims and their parents.MethodsEight sequential adolescent patients that underwent surgery for firecracker-induced severe hand injuries between September 2012 and March 2015 were included. The patient files were assessed for data on hand function. The impact of the injuries was measured by questionnaires and measure instruments: VAS for pain, CHEQ2.0 and COPM-DLV for activities and participation, PedsQL-4.0 for participation and quality of life, RSES for self-esteem, and DT-P for impact on parents.ResultsSeven of the eight patients underwent (partial) hand amputation. Three adolescents still reported pain at a mean of 3.2 years post-trauma. All adolescents required more time than peers performing activities. Seven showed a total of 34 activity and participation problems. One adolescent showed no problems at all. The adolescents showed a mean score of 81 on the PedsQL-4.0, which was not different to healthy adolescents. None had problematic low self-esteem. Six out of eight parents had elevated distress; three parents stated that they still needed psychological support.ConclusionsSevere hand trauma due to firecrackers has an evident impact on hand function and activities in all adolescents. The injuries have a significant long-lasting psychological impact on the parents. Prolonged psychological help is recommended for the adolescents as well as their parents with a more family-centered approach.Level of evidence: Level IV, therapeutic study.

Trends in incidence and correlation between medical costs and lost workdays for work-related amputations in the State of California from 2007 to 2018.

BackgroundDetailed information regarding workers who experience an amputation in the workplace over the last decade is limited. To better understand the financial and functional impact of a work‐related amputation, this study quantifies the incidence of work‐related amputations in the California workforce from 2007 to 2018 as well as the relationship between medical costs and lost workdays as a function of amputation level.MethodsWorkers' compensation claims data from California spanning the years 2007 to 2018 were evaluated to describe trends in amputation incidence (N = 16 931). Quartile values for medical costs, indemnity costs, and lost workdays were reported as a function of amputation level. Correlations were performed between medical costs and lost workdays to examine their relationship.ResultsThe average incidence from 2007 to 2018 was 8.9 (95% CI 8.5, 9.4) amputations per 100 000 workers. There was a significant spike in amputations in 2008. Partial‐hand amputations were the most common with 73.3 (95% CI 69.2, 77.7) cases per 1 000 000 workers, and the industry with the highest incidence was construction with 26.0 (95% CI 22.4, 30.0) cases per 100 000 workers. Overall, medical costs were moderately correlated with lost workdays (Spearman's rho = 0.51), and that level of correlation remained relatively consistent across all levels of amputation (Spearman's rho = 0.48‐0.62).ConclusionsAmputations represent high medical costs and number of lost workdays. Considering the type of amputation and the industry the injury occurred in is important in order to work toward returning this population to work. Our results present the status of amputations in the California workplace and establish a basis for using medical costs to infer lost work productivity for this population.

Targeted Muscle Reinnervation in Partial Hand Amputations.

SummaryTargeted muscle reinnervation (TMR) surgery has been shown to aid in prevention and treatment of neuropathic pain. Technical and anatomical descriptions of TMR surgery for upper extremity amputees (including transradial, transhumeral, and forequarter amputations) have been reported, yet such descriptions of TMR surgery for partial hand amputations are currently lacking. Herein we outline the technique of different types of partial hand amputation TMR surgeries to serve as a reference and guide. A retrospective review was performed by our multi-institutional team to identify clinical cases where partial hand TMR surgeries were performed. Patient demographics, characteristics, amputation subtype, nerve transfer, pain score, pain outcome, and functional outcome data were collected and analyzed. From January 2018 to September 2019, 13 patients underwent partial hand TMR procedures. Eight cases resulted from trauma, and 6 were secondary to oncologic procedures. The amputations consisted of 8 ray, 2 trans-metacarpal, 2 radial-sided hand, and 1 index finger amputation with recurrent painful neuromas. Twelve patients were weaned off narcotics completely and only 3 remained on a neuromodulator for ongoing pain control. Technical considerations for partial hand TMR surgery have been outlined, with early pilot data showing beneficial pain control outcomes.

Pattern of upper limb amputation associated with lower limb amputation: the UK military experience from Iraq and Afghanistan

IntroductionThe conflicts in Iraq and Afghanistan resulted in large numbers of personnel sustaining extremity injuries. In the context of polytrauma, partial hand amputation is often unrecorded. The aim of this...