Reconstructive Effort for the Treatment of Lost Arms: The Multi Disciplinary Approach to Patients Suffering from Upper Extremity Limb Loss 8331

Approximately 41,000 Americans currently live with upper limb loss. These injuries most frequently result from trauma and affect males younger than 45 years (1), though are psychologically and functionally devastating across all demographics and etiologies (2). Inadequate insurance, rural location, limited specialized rehabilitation services, and long, arduous prosthetic fittings remain common barriers to comprehensive upper extremity amputation treatment (3–5). Further, many capable upper extremity surgeons are dissuaded from operating on patients with limb loss by the lack of a logistical model for their complete care. Innovative surgical management of the upper extremity amputee, with focus on targeted muscle re-innervation for neuropathic pain mitigation and myoelectric prosthesis optimization, has been well described (6–10). A few authors have emphasized the importance of a multi-disciplinary, team approach to the upper limb amputee —environmental and psychological factors are often tantamount to surgical challenges for these patients, necessitating a holistic approach (2,10,11). We detail the efforts required to create a successful multi disciplinary approach to the patient with upper limb loss with hopes of expanding access for patients with complex, yet often surmountable obstacles to recovery.

The symposia will detail the 4 pronged approach to patients with upper extremity limb loss, and articulate with clarity the absolute need for each member of this comprehensive team. The team, comprised of surgery, rehabilitation, prosthetics, and physiatry/behavioral health, works in concert to ensure that no components of a patient's care paradigm is missed or lost. The symposia will detail that without this comprehensive approach to the patient, there will be components of the care that will be missed and the patient will potentially suffer. We will detail numerous case examples that demonstrate both the positive effects of the comprehensive model as well as the negative effects when components of the multi disciplinary approach are not available. We will detail the critical importance of the non-surgical members of the team, and clearly delineate that in many respects, the surgeon is the least valuable member of the team.

With this information in hand, attendees who are currently participating in the care of patients suffering from limb loss can return to their home institutions and incorporate strategies to improve the care of their patients. For those attendees who are interested in providing treatment to this patient population, this symposia will give an opportunity to obtain a logistical blueprint for how to go about establishing such a clinic. It will be made clear that the only goal the authors/presenters have in mind is to ensure each and every patient suffering from such devastating life events can obtain the care they deserve and be made whole once again.