WHY AND HOW

NERVE STUMP IN
TRAUMATIC DIGITAL
AMPUTATION

Phedy
First…
 Traumatic Digital Amputation Replant or
Repair Stump?
Associated life-threatening injury
Age
Occupation
Dominance of the injured hand
Condition of the nerve
Severe contamination of the injured part
Segmental injury

•Kim SE, Chung KC. Replantation. In: Chung KC, editor. Hand and wrist surgery:
operative techniques. Saunders: Philadelphia, 2008.p. 825-34
Repair Stump
 Goals:
Mobile
Stable
Useful
Painless

•WilhelmiBJ, Weiner EL. Digital amputations. Available from

http://www.emedicine.com/orthopaedics/18768245.htm. Cited on April 7th, 2009.
Painful amputation
stump
 Neuropathic pain:
Inflammation
neuroma
 Bony prominences
 Contracture

 Lewin-Kowalik J, Marcol W, Kotulska K, Mandera M, Klimczak A. Prevention and management of painful neuroma.
Neurol Med Chir 2006; 46:62-8
 Calandrugccio JH. Amputations of the hand. In: CanaleST, ed. Campbell ‘s Operative Orthopaedics , 11th Ed.
Mosby:Pensylvania 2008.p.639-74
Neuroma
 Bulb-shape thickening created by improperly
and irregulary regenerating nerve
 Enhanced by mechanical stimulation, for
example, the constantly rebuilt scar at the
injury site

 WilhelmiBJ, Weiner EL. Digital amputations. Available from

http://www.emedicine.com/orthopaedics/18768245.htm. Cited on April 7th, 2009.
 Calandrugccio JH. Amputations of the hand. In: CanaleST, ed. Campbell ‘s Operative
Orthopaedics , 11th Ed. Mosby:Pensylvania 2008.p.639-74
Neuroma prevention
 Many Ideas
 Limited evidence
 None has been accepted as the standard
 Some recommendations:
laser or scissors transection methods
capping of nerve stump
traction neurectomy

 Lewin-Kowalik J, Marcol W, Kotulska K, Mandera M, Klimczak A. Prevention and management of painful neuroma.
Neurol Med Chir 2006; 46:62-8
Traction neurectomy
 Principle:
Nerve end in a position away from the stump end
Anticipated point-of-contact pressure
 Performed bilaterally for each digital amputation
 Longitudinally distract in the distal direction then
transect allow proximal retraction
 Resec at least 6 mm proximal

 Calandrugccio JH. Amputations of the hand. In: CanaleST, ed. Campbell ‘s Operative
Orthopaedics , 11th Ed. Mosby:Pensylvania 2008.p.639-74
 WilhelmiBJ, Weiner EL. Digital amputations. Available from
http://www.emedicine.com/orthopaedics/18768245.htm. Cited on April 7th, 2009.
Terima
Kasih