Chapter 17 Finger and Ray Amputation
ADVANTAGES OF WALANT VERSUS SEDATION AND TOURNIQUET FOR FINGER AND RAY AMPUTATION
Losing a finger is a major event in a patient′s life. You get a precious 1-hour opportunity during the surgery to educate the patient on what to expect for recovery and future hand function. This can go a long way toward helping the patient to adapt to the physical changes in the hand.
The patient gets to see what you remove. For example, you can open up a destroyed finger after removing it and offer to show the damaged parts to the patient. If he or she wants to see it, we have found that the individual may better understand and accept why an attempt to salvage the finger never was going to work. This can help in the “grieving” process for the amputated part.
Patients get to see that all of the remaining parts of their hand have a full range of active movement after the amputation, at the end of the operation. After patients recover from the pain and stiffness of surgery, they realize that with therapy they can regain full movement in the remaining fingers.
All of the general advantages of wide awake hand surgery listed in Chapter 2 apply to both the surgeon and the patient.
WHERE TO INJECT THE LOCAL ANESTHETIC FOR FINGER AMPUTATION
See Chapter 1, Atlas, for more illustrations of the anatomy of tumescent local anesthetic in the forearm, wrist, and hand.