Name of the Procedure:

Transmetacarpal Amputation; Re-Amputation

Summary

This surgical procedure involves removing a portion of the hand across the metacarpal bones. A re-amputation is performed if the initial amputation didn't heal properly or complications arose, necessitating further surgery to ensure proper function or prevent infection.

Purpose

Medical Condition or Problem: Severe trauma, infection, or non-healing wounds of the hand can require this procedure.
Goals and Outcomes: The primary goals are to remove damaged or infected tissue, improve function, and prevent further health complications.

Indications

Symptoms or Conditions: Severe injury, chronic infection, gangrene, or unmanageable pain in the hand.
Patient Criteria: Patients with irreversible tissue damage or necrosis that cannot be salvaged by other means.

Preparation

Pre-Procedure Instructions: The patient may need to fast for several hours before the surgery. Adjustments to medications, particularly blood thinners, will be required.
Diagnostic Tests: Blood tests, imaging studies (X-ray, MRI), and sometimes vascular studies to assess blood flow.

Procedure Description

1. Anesthesia: General or regional anesthesia is administered to ensure the patient does not feel pain during the operation.
2. Incision: A tourniquet is applied to minimize blood loss. The surgeon makes an incision across the metacarpal bones.
3. Removal: The affected tissue and possibly some bone are removed.
4. Closure: The remaining tissue is shaped and closed over the bone edge to form a smooth end, which will heal into a functional stump.
5. Dressing: A sterile dressing is applied to protect the wound.

Tools and Equipment: Scalpels, saws, forceps, tourniquet, and surgical sutures.

Duration

The procedure typically takes about 1 to 2 hours.

Setting

This surgery is usually performed in a hospital operating room or a specialized surgical center.

Personnel

The surgical team often includes the lead surgeon, a surgical assistant, a scrub nurse, a circulating nurse, and an anesthesiologist.

Risks and Complications

Common Risks: Infection, bleeding, and pain.
Rare Risks: Nerve damage, poor wound healing, or need for further surgery.
Management: These complications are usually managed with antibiotics, pain medication, and additional interventions as needed.

Benefits

Expected Benefits: Removal of diseased or damaged tissue can improve function, reduce pain, and prevent the spread of infection. Timeline: Benefits are often noticed shortly after recovery, with gradual improvement as healing progresses.

Recovery

Post-Procedure Care: Keep the wound clean and dry, follow prescribed pain management, and attend all follow-up appointments.
Recovery Time: Generally, several weeks to a few months, with restrictions on heavy lifting and encouraged rehabilitation exercises.

Alternatives

Other Options:

• Conservative Management: Antibiotic therapy or wound care techniques.
• Limb Salvage Surgery: Attempts to save the limb using reconstructive surgery.
• Pros and Cons:
  • Conservative Management: Less invasive but might not resolve severe cases.
  • Limb Salvage: Potentially more complex with longer recovery but preserves more of the hand.

Patient Experience

During the Procedure: The patient will be under anesthesia and won't feel pain.
After the Procedure: Some pain and swelling are expected, managed with medication. Emotional and psychological support may also be beneficial during recovery.