Finger/partial hand amputation – what now?
Our hands combine sensory, motor as well as social functions. They are always visible – and are a way of introducing ourselves when giving a first impression: Are our hands clean? Are the fingernails cared for? We often shake hands when greeting each other. Concluding a contract is sealed with a handshake. As an amputee, how do I handle such situations with my amputation?
Today, amputated limbs can be replaced with a hand and finger prosthesis. These prostheses are made of silicone and look deceptively real. A silicone hand or finger prosthesis often goes unnoticed at first in everyday life.
Causes for the amputation
What are the reasons for a finger or hand amputation?
Doctors always try to avoid a finger or hand amputation. Thanks to advances in surgery, fingers and hands can be preserved along with their functions in an increasing number of cases. However, amputations may be unavoidable to maintain your health on a sustainable basis in the event of severe diseases or injuries.
Accidents (trauma) are the most common cause for finger amputations. An accident may occur at work or during recreation, for example, while working a trade or participating in sports. Accidents are a cause for amputations that can occur in all age groups. Congenital limb differences (dysmelia) are another possible cause. Limb differences may be caused by a genetic defect, by external factors such as infections or as a side effect of medications (for example, thalidomide in the drug Contergan).
Replantation – not always an option
A severed finger or hand can be reattached in some cases (replantation). A replantation is always a difficult operation. It represents a highly complex task for the surgeon, especially in the area of the hand. A prerequisite for replantation is that the severed body part reaches the surgeon in as unaltered a condition as possible.
The severed limb should be protected from moisture. Pack it
1. dry in sterile bandages
2. then in a plastic bag with a water-tight seal
To cool the limb during transportation, the sealed bag with the limb should be placed in a mixture of water and ice. The body part must not come into direct contact with water or ice.
What amputation types are there?
Our hands enable us to execute a variety of complex movements, so we use our fingers and hands for many different purposes every day.
Your surgeon will do everything in their power to preserve as much of your hand as possible. Hand and finger amputations are performed at various heights called amputation levels.
The extent of the injury determines the amputation level. When the entire hand has to be amputated at the wrist, this is known as a hand amputation. A finger amputation is when one or more fingers have to be amputated. Any amputation between a finger and hand amputation is a partial hand amputation.
The new hand
After an amputation, modern orthopaedic technology makes it possible to treat the affected hand with a hand, partial hand or finger prosthesis.
The design of your hand or finger prosthesis depends on the amputation level: if the residual limb length is at least 2 cm after a finger amputation, fitting a silicone finger prosthesis is generally possible. If the residual limb is shorter or part of the hand is missing, a silicone partial hand prosthesis is used.
Incidentally, the number of amputated fingers has no influence on the decision to carry out a fitting with finger prostheses or a partial hand prosthesis.
It’s impossible to make a general prediction about which functions your hand will be able to perform again with a prosthesis, or what your hand will look like after an amputation. The residual limb situation varies considerably between individuals. Questions regarding this are answered during an individual consultation and in the trial phase of treatment with a prosthesis.
What happens after the amputation?
Further treatment begins directly after the amputation. The wound has to heal and the residual limb must be shaped.
Qualified personnel take care of post-operative treatment of the residual limb with regular changes of the compression bandages. The goal is to eliminate the accumulated blood around the wound and the retained tissue fluid more quickly, reducing the residual limb volume. Slight targeted pressure is applied with compression bandages to also compress the residual limb as far as possible. If the residual limb is to be subsequently fitted with a silicone prosthesis, using silicone compression aids at this point is recommended.
It’s impossible to predict how much time it will ultimately take for the wound to heal. The wound healing period varies considerably and is also influenced by other factors, such as accompanying illnesses (diabetes for instance) or nicotine consumption.
Living with the amputation
Take time to get used to your new situation. While the amputation of a finger is a relatively minor limb loss, it is nevertheless a surgical procedure. An amputation affects both the functionality and the appearance of your hand. At first you will find the situation unusual: you need to learn what you are still able to do after the amputation, and which functions are no longer available. For many affected individuals, the initial effects of the amputation are quite considerable.
The loss of a finger or parts of the hand sometimes affects behaviour in public. Some of those affected prefer to hide their hand from others. In rare cases, patients have difficulty accepting their hand after an amputation. When this happens, the affected person should accept help and, in addition to occupational therapy, take part in post-amputation therapy.
It is important to note that you alone decide how to handle your amputation going forward.
Treatment with a prosthesis may be an option that lets you resume your life as usual after the amputation.
Living with a prosthesis
Thanks to the use of modern materials and techniques, lost fingers or parts of the hand can be replaced with a finger or partial hand prosthesis. The decision whether you want to wear a prosthesis or not is entirely yours.
If you can answer “yes” to the following questions, treatment with a prosthesis should be an option for you. However, this “quick check” isn’t a substitute for a personal consultation with an O&P professional:
Has your residual limb healed?
Is your residual limb volume stable?
As a rule, using a prosthesis is possible even if you have a bony residual limb or a residual limb with areas of sensitive skin. Sometimes treatment with a prosthesis is actually recommended in such cases. This is because the prosthesis reliably shields the sensitive residual limb from direct contact, and the prosthetic socket is customised to the individual’s specific situation. Please note that a prosthesis is a device to help you but cannot entirely replace the complex functions of the hand. Certain limitations have to be accepted, even if you are treated with a prosthesis.
What are all the things I can do with a hand or finger prosthesis?
The prosthesis will help you to regain as much as possible of the function lost due to the amputation. You will again be able to hold and grasp objects passively - the prosthesis will allow you to hold them against your remaining fingers or thumb. This will avoid unilateral strain and enable a balanced sequence of movements. Restoring the whole palm also enlarges the usable area of the amputated hand. Regaining these functions can help restore your confidence and independence.
What are the benefits of a finger/partial hand prosthesis made of silicone?
Your silicone prosthesis fulfils numerous technical and social functions. The following is a summary of what a silicone prosthesis has to offer:
Very comfortable to wear
Thin socket brims
Good skin compatibility
Anatomically correct shape
The prosthetic socket provides secure fixation and is very comfortable to wear. The socket forms the link between your residual limb and the prosthesis. It is custom fabricated for your residual limb. The prosthetic socket uses a vacuum to create a firm, direct connection between the prosthesis and your residual limb. As a result, the finger prosthesis is reliably fixed to the residual limb in any position and during all grasping movements.
At the same time, the custom fabricated prosthetic socket is very comfortable to wear thanks to the use of materials with different degrees of hardness. This is particularly advantageous for users with problem areas on their residual limb – for example, when the skin on the residual limb is especially sensitive, or the end of the residual limb is bony.
While this may sound strange, the aesthetics as such represent a function: when you accept how your hand looks, you won’t hide it in your pocket. The anatomically correct shape and colour of the hand are restored to look deceptively real, ensuring relaxed interactions with others – a key aspect in helping you integrate into everyday social and professional life.
Frequently asked questions about hand/finger prostheses
How do I get a silicone prosthesis?
Prescribing a prosthesis involves your doctor, the O&P professional you have chosen yourself and the paying party – usually a statutory health insurance provider or employers’ liability insurance association.
Start by talking to your doctor about the possibility of a hand or finger prosthesis.
During your first appointment with your chosen medical supply company, your O&P professional will tell you about the treatment options that can be considered for you during the consultation. You are free to choose your O&P professional.
Once you decide on a prosthesis, you will have a second appointment with the medical supply company. The O&P professional measures your hands and takes molds and photos. A trial prosthesis is then fabricated based on these data.
Shortly thereafter, you receive this trial prosthesis to wear and test for two to four weeks. Above all, testing the finger position in various everyday situations is key. This trial prosthesis is also used to very the exact fit on your residual limb, ensuring that the prosthesis will be comfortable for you to wear over the long term.
Based on your experiences with the trial prosthesis, the final prosthesis is then fabricated in consultation with your O&P professional. You receive your final prosthesis about three weeks after the end of the trial phase.
How do I put on and take off a hand/finger prosthesis?
Your hand or finger prosthesis is very easy to use. The silicone material is elastic and stretches when you put on the prosthesis. Zips or other openings are therefore unnecessary.
We recommend using ProComfort gel to make sliding into the prosthetic socket easier. Please do not use any other substances without first consulting your O&P professional. There is a risk that the ingredients may damage your skin or the prosthesis.
Taking the hand or finger prosthesis off is very simple as well. Specific movements at the socket brim allow air to enter, releasing the vacuum adhesion. You can use a small rod to let air in while taking the prosthesis off. No other devices are required.
How do I care for a silicone prosthesis?
Cleaning is as easy as washing your hands every day: the best way to clean your prosthesis is just with lukewarm water and pH-neutral soap. Wash the inside as well as the outside in order to remove perspiration residue. To remove tough dirt and oils from your silicone prosthesis, we recommend immersing it in boiling tap water for 15 minutes every six weeks.
It’s important to make sure your prosthesis doesn’t come into contact with solvents or other chemicals. This applies while wearing the prosthesis and also for cleaning. Solvents not only penetrate the silicone and destroy it, they are also transferred to the skin while wearing the prosthesis. Contact between the prosthesis and creams such as hand creams as well as perfumes should also be avoided.
If you paint the (acrylic) nails on your finger prosthesis, please ensure that neither nail polish nor remover comes into contact with the silicone material of your prosthesis. Otherwise, the silicone will be damaged. Acrylic nails are also suitable for nail design. You can continue wearing any type of jewellery with a silicone prosthesis as well.
How do I care for my residual limb?
The properties of the silicone material we use have a positive effect on your skin. It is breathable, skin-friendly and helps prevent skin irritation.
If you have highly sensitive areas on your residual limb, such as very thin skin or a scar contracture, the prosthesis protects these areas against direct contact. This is especially advantageous for sensitive residual limb situations in terms of preventing pain and subsequent injuries.
Please monitor your residual limb for changes and contact your doctor if necessary. Please also contact your doctor if your scars should harden or become less flexible.
For residual limb care, please take your prosthesis off at night to improve the regeneration of your skin on the residual limb.
What do silicone finger and partial hand prostheses look like?
Silicone enables a precise replication of the shape and length of the fingers in relation to the physical proportions. The socket brims are thin and tapered, forming a smooth transition.
Your skin colour can be replicated in detail with silicone. Moles, veins or arm hairs can also be integrated into the prosthesis if desired.
Please be aware that the nuances of your skin colour are always changing. Unlike your hand, the silicone of the prosthesis is non-living and will not be able to adapt to these natural colour fluctuations.
Up to five colours are used to design the fingernails. You can also paint the fingernails or apply nail designs if you like. For the colour design, you can choose between the three variants “Basic”, “Classic” or “Natural”. Different configurations can be chosen for these variants.
Your custom finger prosthesis is fabricated according to your choices.
What is a silicone prosthesis made of?
Your prosthesis is made of skin-friendly silicone. Silicone does not cause allergic reactions. Thanks to these properties, you can wear your silicone finger prosthesis frequently and for long periods of time. The shape of your prosthesis remains stable, and it does not become porous because it doesn’t contain any softeners.
Silicone is also suitable for designing an exact appearance down to the smallest details – the replica of your amputated finger is deceptively real. Painting your fingernails and wearing jewellery are also possible with the silicone prosthesis.
Silicone is resistant to fresh and salt water and to UV radiation. A silicone prosthesis is virtually unrivalled in terms of hygiene as well.