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Upper-Extremity Amputation Surgery and Prosthetic Prescription
Robert MazetJr.; Craig L. Taylor; Charles O. Bechtol
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Prosthetic Laboratory, Department of Engineering, University of California at Los Angeles; the Department of Surgery, School of Medicine, University of California at Los Angeles; and the Wadsworth General Hospital, Veterans Administration Center, Los Angeles
1956 by The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 1956 Dec 01;38(6):1185-1198
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Inasmuch as a number of persons with amputations in the so-called undesirable areas have been successfully fitted with appliances developed in recent years, it is our contention that the concept of "sites of election" in upper-extremity amputations is obsolete. Amputation surgery of the upper extremity should be directed toward saving all possible length in all areas. Prosthetic considerations need not dictate the amputation site. Physical aspects, such as skin coverage, adequacy of circulation, good innervation, and function of the part to be saved, should be the determining factors in the decision as to the level of amputation.

Familiarity with the latest techniques of prosthetic manufacture and fitting are as essential for the surgeon as his knowledge of surgical techniques. Realization of the potentialities and limitations of recently developed prosthetic appurtenances are necessary for the prescription of the appliance best suited to the needs of the individual. Functional prosthetic replacements are available for almost all types of upper-extremity amputations10 {Fig. 15}. Prescription of the prosthesis which is best suited to the individual requirements of the patient is the privilege of the surgeon. This cannot be delegated.

The surgeon should share the responsibility for amputee rehabilitation with the other members of the prosthetic team (the patient, therapist, trainer, prosthetist, job counselor, and psychologist), but he must remain captain. His responsibility to the patient does not terminate with wound healing. It continues through the period of rehabilitation. He must, with cooperation from other team members, supervise the readjustment of the patient to his handicap and direct the restoration of the patient to social and economic independence.

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    amputation ; arm
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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