- Principles
- Preserve maximum functional length and adjacent digit function
- Create a pain-free, durable, sensate stump
- Maintain hand/foot biomechanics when possible
- Steps
- Tourniquet applied proximally
- Longitudinal dorsal and volar skin flaps marked (fishmouth)
- Skin incision and dissection down to the bone
- Identify and divide digital vessels and nerves
- Ligate arteries, cauterise or bury nerve ends to prevent neuroma
- Disarticulate at joint or divide bone if required
- Smooth bone edges with rongeur
- Fashion soft tissue flaps to provide tension-free coverage
- Suture closure in layers
- Sterile dressing and compression wrap
- Postoperative care
- Elevation and pain control
- Monitor perfusion and wound healing
- Early physiotherapy to prevent stiffness
- Wound review and dressing changes as required
- Types
- Terminal (tip) amputation
- Partial or complete phalangeal amputation
- Ray amputation (removal of digit + corresponding metacarpal/metatarsal)
- Complications
- Wound infection or dehiscence
- Neuroma formation
- Poor cosmesis or function
- Joint stiffness or adjacent digit deformity