Bridging the Gap Between Hand Surgery and Partial Hand Prostheses
Posted by Dr. Jacques-Henri Hacquebord
Monday, Jul 15
How many times have we, as therapists, prosthetists, and rehabilitation nurses, encountered a traumatic hand injury where the heroic efforts of a skilled microvascular hand surgeon saved the hand? Yet what does it mean to “save” a hand following many months of reconstructive procedures that may include replantation, deepening a web space, a free flap, pedicle flap, debulking, or toe-to-hand transfer?

How many times have we, as therapists, prosthetists, and rehabilitation nurses, encountered a traumatic hand injury where the heroic efforts of a skilled microvascular hand surgeon saved the hand? Yet what does it mean to “save” a hand following many months of reconstructive procedures that may include replantation, deepening a web space, a free flap, pedicle flap, debulking, or toe-to-hand transfer? In the end, what is the status of sensation, adequate range of motion, opposition, and functional grasp restoration? And is the appearance acceptable to the individual with partial hand loss?

It is difficult for many in hand therapy and prosthetics to keep up with these advances, and even more so for hand surgeons, as the options and advances are not taught or included in hand surgery texts.

A multidisciplinary team recently addressed this issue in an article in the journal Hand, “Hand Surgeons’ Understanding of Partial Hand Prostheses: Results of a National Study,” that concluded, “Overall, hand surgeons are unfamiliar with modern partial hand prosthetic devices. Most of the cohort denied working within a multidisciplinary hand team (76.2 percent) or consulting with a prosthetist prior to revisional surgeries (71.4 percent).”

What strategies can we take to share our knowledge with hand surgeons? And equally important, how can we learn about the rationale and techniques microvascular hand surgeons use to save a hand? How can we integrate and expand these skill sets to enhance the patient outcomes?

These questions were posed to two outstanding hand surgeons, Jacques Hacquebord, MD, and Omri Ayalon, MD, at the Center for Amputation Reconstruction (CAR) at New York University’s (NYU’s) Department of Orthopedic Surgery. They believe that much of the challenge within the hand surgery community has been surgeons’ perception of amputation as defeat and an outcome with no further options, and that surgeons remain unaware of the prosthetic options that can significantly advance a patient’s functional level. Because of the ever-increasing sophistication of prostheses, especially those for partial hand amputations, it is important that hand surgeons begin to see optimizing these patients for prosthetic fitting as a form of bionic hand reconstruction. Just like more traditional hand reconstruction, bionic reconstruction requires a very specific skill set and fund of knowledge.

Unlike traditional reconstruction though, bionic reconstruction has the intention of surgically preparing a patient’s anatomy to best receive and interact with a prosthesis. However, this also demands of the surgeon to work within a multidisciplinary team from the outset and understand the critical role that the team plays at every part of the patient’s care.

Hacquebord states, “The advancement of care for our patients requires that we bridge the gap between surgery and prosthetics. The first step in doing so requires that not only hand surgeons, but all of us become aware of the burgeoning field of bionic reconstruction.”

To address this challenge, CAR has designed a multidisciplinary, surgically focused conference, Bionic Reconstruction (BReCON): The Future of Integrated Upper Limb Surgical and Prosthetic Innovation, being held November 30-December 1 at NYU.

This conference will include some of the world’s most prominent upper-limb surgeons, prosthetists, and therapists. Topics will not only include all levels of the upper limb, but also osseointegration, pain, brachial plexus injury, sensory feedback, and other areas of vital interest and study. I encourage O&P professionals to attend this unique event to further the conversation.

Diane Atkins, OTR/L, FISPO, is an assistant clinical professor in the Department of Physical Medicine and Rehabilitation at Baylor College of Medicine.

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