3+4+Supplementum/2012 - Společnost pro pojivové tkáně

fourth is transverse deficiency, in which
the critical period is not known. Based on
these studies, the author modified IFSSH
classification and it was adopted by the
Japanese Society for Surgery of the Hand
and is called Japanese modification of the
IFSSH classification (Japanese modification).
In this paper, the author introduced
the Japanese modification of the IFSSH
classification and described some recommendations.
key words: longitudinal deficiency,
radial deficiency, ulnar deficiency, cleft
hand, constriction band syndrome, transverse
deficiency, symbrachydactyly
aBSTRakT
SuRGiCal OPTiOnS fOR
funCTiOnal iMPROVeMenT
afTeR uPPeR liMB aMPuTaTiOn.
Georg Neff, Berlin
(former Head of Dpmt. for Technical
Orthopaedics, “Oskar-Helene-Heim”, Freie
Universität Berlin)
Partial or total amputation of an upper
limb is always combined with a loss of
function. In many instances special surgical
procedures and adequate prosthetic
devices – preserving sensory feed-back –
may improve functional capabilities for the
amputee.
A better grip after amputation of the
radial finger rays can be achieved by lengthening
of even a short “left over” of the first
metacarpal according to Matev.
After loss of all fingers “metacarpalisation”
according to kreuz allows for
a pincer grip by resection of the second
334 14 th Prague-Sydney-Lublin
metacarpal, the deepening of the web with
transposition of the m. adductor pollicis
and isolation of the first metacarpal creating
a new short “thumb”.
The kruckenberg procedure after
transradial amputation consists in the separation
of radius and ulna and the preservation
of the essential muscles for active
opening and closing of this pincer. A modified
incision acc. to Marquardt covers the
opposing tips of both branches with fully
sensible flaps. For the public a cosmetic or
a myoelectric prosthesis is adequate.
Sauerbruch’s cineplastic creates muscle
channels for direct voluntary activation
of a prosthesis and extented proprioceptive
control (Childress); it applies for transradial,
transhumeral and shoulder /-girdle
disarticulation.
For transhumeral residual stumps an
angulation osteotomy of the distal humerus
according to Marquardt allows for free
range of motion in the shoulder girdle and
direct transfer of rotation to a snug fitting
prosthesis – either body- or myoelectrically
powered; with an open splint construction
instead of a closed socket much of the posterior
skin is ready for sensory feed-back.
Due to the proximal growth plate transhumeral
amputation in childhood results
in osseous overgrowth and penetration
of the bony spike. Stumpcapping with
an osseous-cartilage graft according to
Marquardt creates a “quasi” disarticulation
stump, prevents further osseous overgrowth
and provides full weightbearing
and additional length.
For Targeted Muscle Reinnervation
according to kuiken after (sub-) total loss
of an arm the nerves of the extremity are
implanted in surgically isolated muscle segments
– e.g. of m. pectoralis major – to
gain more individual signals for control-