Name of the Procedure:

Amputation, finger or thumb, primary or secondary, any joint or phalanx, single, including neurectomies; with direct closure

Summary

In this procedure, a surgeon removes part or all of a finger or thumb at any joint or phalanx (bone segments). It includes cutting nerves (neurectomies) to manage pain and closes the wound directly without skin grafts.

Purpose

This procedure is performed to address severe damage, infection, or disease (like cancer or severe arthritis) in a finger or thumb. The main goals are to alleviate pain, prevent the spread of infection or disease, and improve hand function.

Indications

• Severe traumatic injury to the finger or thumb
• Severe infection not responsive to antibiotics
• Cancerous tumors in the finger or thumb
• Advanced arthritis causing significant pain and dysfunction
• Non-healing wounds or ulcers

Preparation

• Patients may need to fast for a few hours before surgery.
• Adjustments to medications, especially blood thinners, may be necessary.
• Pre-operative assessments may include blood tests, X-rays, and consultations with anesthesiologists.

Procedure Description

1. Anesthesia: Administering local or general anesthesia to ensure patient comfort.
2. Incision: Making an incision around the area to be amputated.
3. Dissection: Carefully dissecting through skin, muscle, and bone.
4. Neurectomy: Cutting nerves to help prevent pain after surgery.
5. Amputation: Removing the affected part of the finger or thumb.
6. Closure: Directly sewing the skin edges together.

Tools used: surgical scalpels, saws for bone, forceps, and suturing materials.

Duration

The procedure typically takes around 30 minutes to an hour, depending on the complexity.

Setting

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

Personnel

• Orthopedic or plastic surgeon
• Anesthesiologist or nurse anesthetist
• Surgical nurses and technicians

Risks and Complications

• Infection
• Bleeding
• Poor wound healing
• Phantom limb pain
• Neuroma (painful nerve growth)
• Loss of function in the affected hand

Benefits

• Relief from severe pain
• Elimination of infected or diseased tissue
• Improved overall hand function

Recovery

• Keeping the wound clean and dry
• Elevation of the hand to reduce swelling
• Pain management with prescribed medications
• Potentially, physical therapy to regain strength and mobility in the hand
• Follow-up appointments for wound inspections and stitch removal
• Expected recovery time varies but typically spans a few weeks to a few months.

Alternatives

• Reconstructive surgery (if feasible)
• Medications or antibiotic therapy (less effective for severe cases)
• Physical therapy (for less severe conditions)
• Pros: Non-invasive alternatives may have fewer risks
• Cons: May not be effective in relieving pain or stopping disease progression

Patient Experience

• During: Anesthesia will prevent discomfort, though the sensation of movement may be felt.
• After: There may be pain and discomfort managed with medications. Swelling and minor bleeding are common.
• Emotional: Patients might experience emotional or psychological impacts due to the loss of part of their finger or thumb. Supportive therapies and counseling can help.

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