Typical amputation of finger in continuity (through a phalanx); long palmar and short dorsal flaps. (Farabeuf.)
Fig. 681
Typical or preferred method of disarticulating a finger by long single palmar flap. (Farabeuf.)
[Figs. 680] and [681] illustrate the best methods of amputating fingers through a phalanx or at the joints, while [Fig. 682] shows the best method of closing the wound. In this way a serviceable finger-tip is preserved which will stand every irritation to which it will probably be subjected.
When the finger is to be disarticulated from the hand a modified oval flap is preferable, with its long flap on the radial side and the scar on the dorsum rather than in the palm. The thumb is perhaps best separated at an articulation by a single palmar flap, without the preservation of the sesamoids which belong to its short flexor. [Fig. 683] illustrates the various flaps and methods preferable at the bases of the different fingers.
When two or more fingers have to be removed the incision should be planned to meet the indications. When the first three fingers have to be removed, with or without that portion of the hand to which they are attached, leaving only the thumb and little finger, I have repeatedly followed to advantage the suggestion of Lauenstein, and through a small incision properly placed have, with cutting forceps, divided the first and fifth metacarpal bones at about their middle, and have then given to each of the remaining digits a quarter of a revolution toward each other, in such a way that when their tips are flexed there was better prehensile power, the hand acting similarly to a more perfect claw. If they are to be maintained in this position during healing they must be suitably held upon the splint to which the entire hand and forearm should be attached.
Fig. 682
