56.5 Amputating through the lower arm and wrist

Losing a hand is a tragedy. Minimize it by trying to preserve as much of the length of a patient’s forearm as you can. An elbow with even a short length of forearm is better than none. If possible, amputate through his metacarpus or wrist, rather than higher up. Ischaemia is an exception. The circulation in the distal forearm; like that of the distal lower leg, is not good. So if his arm is ischaemic, an amputation higher up his forearm may be better than one lower down.

If you have to amputate through his wrist, a plastic surgeon may later be able to make an ’alligator mouth’ out of his two forearm bones, so that he has something to grip with (Krukenberg’s operation). Anteroposterior flaps are better than lateral ones, because the scar cannot retract between the bones.