Fig. 686
Results of amputation above metacarpo-phalangeal articulation in middle, index, and ring fingers. (Erichsen.)
Fig. 687
Hand after removal of metacarpal bones and three fingers, leaving thumb and little finger. (Erichsen.)
When an entire finger is to be removed it is a question whether the metacarpal belonging thereto should also be sacrificed for cosmetic purposes. In general this is undesirable except in the case of the fifth metacarpal with the little finger. This is easily exposed by lateral incision along the ulnar border of the hand, sufficient to disclose the bone and permit its disarticulation from the carpus. The same is also true, in at least some instances, of the thumb, but it is unwise to expose the carpal joints to the possibility of infection when this can be avoided; moreover, the deep palmar arch crosses just in front of the bases of the second to the fourth metacarpals, where it must be carefully avoided. If, then, the metacarpal is to be sacrificed this should be done rather from the dorsal side, while for cosmetic purposes alone it is usually sufficient to disarticulate the finger at its base and then simply remove the head end of the corresponding metacarpal. [Figs. 688] to [692] furnish illustrations of how the incisions may be best planned to effect either of these purposes.
Hand Amputations and Wrist Disarticulations.
—While it makes but little difference whether the metacarpals be disarticulated from the carpus or the latter from the radial end, it is advisable to adopt whichever line of separation will best meet the indications. For a removal of the hand at or near the wrist two flaps usually afford the most serviceable method, the palmar tissues being preserved, if possible, in order that they may cover the stump. This operation is usually done for injury, and it is more than likely that one will have to plan his flap according to the tissues which still are serviceable.
Fig. 688