Prosthetic reconstruction to restore function in transcarpal amputees.

Mutilated hands at the distal level may pose a challenge for reconstruction. Biological treatment options may require multiple surgical interventions and a long rehabilitation course with little hope of good functional outcome. Standard hand prostheses are also not an ideal solution, as they are too long and cumbersome for partial hand injuries. This paper outlines the functional outcomes of prosthetic reconstruction with devices customized for the transcarpal amputation levels. The functional outcome was evaluated with the Action Research Arm Test (ARAT), Southampton Hand Assessment Procedure (SHAP), and the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH). Functional evaluation was performed at least 12 months after final fitting. Psychological assessment was performed with the Short Form-36. The three patients achieved a mean ARAT score of 35.67 ± 0.58. The average SHAP score was 74 ± 7.81. The average DASH score was found to be 16.11 ± 12.03. The reconstructed hand achieved a score of 75.27 ± 8.16% in SHAP and 62.57 ± 1.02% in ARAT in relation to the healthy hand. All patients exhibited average physical and mental component summary scales in the Short Form-36. The majority of transcarpal amputations are seen in manual laborers due to work-related trauma. Returning to work is the main goal in such young and otherwise-healthy patients. As shown with this study, prosthetic fitting results in quick and reliable functional reconstruction. Therefore, this treatment should be considered as an option during the initial decision-making process of reconstructing difficult traumatic injuries of the hand.
(Copyright © 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)