Chapter 17 Finger and Ray Amputation



10.1055/b-0037-142188

Chapter 17 Finger and Ray Amputation

Donald H. Lalonde

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

Palmar injections: Inject 10 ml of 1% lidocaine with 1:100,000 epinephrine (buffered with 1 ml of 8.4% sodium bicarbonate) in the most proximal palmer red injection point. Place the most proximal dorsal injection next, then inject 2 ml in the middle of each of the palmar proximal and middle phalanges in the subcutaneous fat. Performing the proximal dorsal injection before the two distal palmar injections gives it time to be blocked.
Dorsal injections: Inject 4 ml of 1% lidocaine with 1:100,000 epinephrine (buffered with 0.4 ml of 8.4% sodium bicarbonate) in the proximal red injection dot on the dorsal hand. Do the two palmar injections next, and then inject 2 ml in the middle of the dorsal proximal and middle phalanges in the subcutaneous fat.



  • See Chapter 1, Atlas, for more illustrations of the anatomy of tumescent local anesthetic in the forearm, wrist, and hand.

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May 29, 2020 | Posted by in ORTHOPEDIC | Comments Off on Chapter 17 Finger and Ray Amputation

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