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Major Upper Extremity Amputations and Prosthetics: Comparison of Prosthetist and Surgeon Preferences
Ramsen Azizi, MD1; Jessica Korsh, MS1; Michael Singer, BS1; Abe Mathews, CPO2; Brian Pinsky, MD1
1Plastic Surgery, Long Island Plastic Surgical Group/Nassau University Medical Center, Garden City, NY; 2Orthotics and Prosthetics, Progressive Orthotics and Prosthetics, Albertson, NY

Background: Approximately 41,000 Americans are living with a major upper extremity amputation and up to 50% discontinue use of their prostheses within the first year. Studies of the population have been rare and mostly patient based via survey. No studies have been done on surgeon or prosthetist preferences.

Purpose: 1) Assess and compare the current state of knowledge among hand surgeons and prosthetists regarding the surgical planning for upper extremity amputations, 2) Propose surgical guidelines to optimize prosthesis fitting in major upper limb amputations.

Materials and Methods: A 34 question survey was developed by a team consisting of a board certified plastic/hand surgeon and a certified prosthetist. The questionnaire was sent to members of the American Association of Hand Surgery (AAHS) and the American Society for Surgery of the Hand (ASSH) after obtaining appropriate approval. Additionally, the survey was sent to subscribers of www.oandp.com, an online resource for orthotics and prosthetics professional. The study queried preferences in optimal amputation length, intra-operative decision-making process, the balance of soft tissue vs. length, and post-operative therapy of amputees.

Results: Twenty-nine ABCOP certified prosthetists, 2 CPc certified prosthetists, 1 hand/ occupational therapist, and 154 physicians or surgeons responded to the survey. When determining intraoperative stump length, only 52% considered prosthetic fit. There was agreement between the two groups that both stump length and soft tissue were important factors, but prosthetists placed a greater emphasis on proper length over soft tissue coverage. When asked about optimal trans-radial stump length, the majority of surgeons (55%) favored the distal 1/3; however, prosthetists favored the middle 1/3 (61%). Both surgeons and prosthetists agreed that the minimum stump length needed distal to the elbow was 5-10cm. For Trans-humoral stump length, the majority of surgeons felt the supracondylar ridge was optimal (46%) but prosthetists favored the middle 1/3 (76%). All parties agreed that early prosthesis intervention was ideal; however, the time from operation to prosthetic fitting was >4 weeks in 49% of cases and 1-4 weeks in only 33%.

Conclusion: There remain many discrepancies between prosthetists and surgeons regarding upper extremity amputations. Data suggests that surgeons may be able to surgically plan for a shorter amputation stump in the middle 1/3 of the forearm or upper arm, which may allow for better soft tissue coverage and improve prosthesis fit. Our hope is this data opens a dialogue among those treating patients with major upper extremity amputations during the perioperative period.

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