c l i n i c a l f o l i o s : d i s c u s s i o n

Trans-Radial Forearm Amputation



Related narrative: Trans-Radial Forearm Amputation

Amputation of the upper extremity at the level of the forearm is often the result of a traumatic assault that leaves the hand unsalvageable (1). The surgeon should present these challenges and openly communicate to the patient prior to any amputation unless the patient's life is at risk from the injured extremity. The following technique describes the trans-radial distal forearm level amputation in detail to allow for pre-operative planning.

Several salient points to consider when planning an upper extremity amputation. The mantra "all possible length should be preserved in upper extremity amputations" should be tempered by the ability of the remaining tissue to heal and the resources available to the patient following the amputation. The traumatic wound will often dictate the level of amputation, however, very distal upper extremity amputations in the forearm are noteworthy for the thinner subcutaneous layers under skin flaps and more avascular structures (i.e. tendons) in the distal forearm, both which may complicate wound healing. Conversely, very proximal forearm amputations will require custom prosthetic fitting challenges to the prosthetist.

Myodesis, transferring muscle to bone, is routinely performed in lower extremity amputation to rebalance muscle control of the stump (2). Myoplasty, attaching muscle to muscle, provides adequate stump coverage with muscle. In the trans-radial forearm amputation, careful myodesis can prevent stump prominence while myoplasty will ensure functional muscle activity that can be used for myoelectric prostheses (1). No studies have shown the necessity of myoplasty in forearm amputees, but the technique is included here and routinely performed by the author.

Last, heterotopic ossification, is a common complication of upper extremity amputations (3,4). This will be most frequently seen in patients with concomitant head injury, amputations performed within the zone of injury, and severity of injury. Prophylaxis is not routinely utilized for primary amputations, but in HO formation, post operative local radiation therapy or NSAID's can be used to decrease the risk of recurrence (5).


1. Tintle SM, Baechler MF, Nanos III GP, et al. Traumatic and trauma-related amputations: Part II: Upper extremity. JBJS (A) 2010; 92:2934-45.

2. Shawen SB, Doukas WC, Shrout JA, et al. General Surgical Principles for the Combat Casualty with Limb Loss. In: Lenhart MK ed., Combat Care of the Amputee, Washington DC, Borden Institute, 2009.

3. Tintle SM. Operative complications following combat-related major upper extremity amputations. JHS (A) 2010; 35 (10): Suppl 53-54.

4. Garland DE. Clinical observations on fractures and heterotopic ossification in the spinal cord and traumatic brain injured populations. Clin Orthop Related Res, 1998; 233: 86-101.

5. Ring D, Jupiter JB. Operative Release of Ankylosis of the Elbow Due to Heterotopic Ossification. JBJS (A) 2003; 85: 849-853.

6. Sage HC, Papp S, Dipasquale T. The effect of suture pattern and tension on cutaneous blood flow as assessed by laser Doppler flowmetry in a pig model. J Orthop Trauma, 2008; 22(3): 171-5.

This page was last modified on 15-Jun-2011.