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Forearm amputations are a life-changing but often unavoidable procedure, most commonly needed secondary to trauma. These are a complicated process, and patients must be managed holistically. This activity outlines forearm amputations and highlights the interprofessional team's role in managing this condition. Objectives: Identify the indications for forearm amputations. Outline the technique involved in forearm amputations. Summarize the main complications associated with forearm amputations. Explain the importance of collaboration and communication among the interprofessional team to improve outcomes for patients affected by forearm amputations. Access free multiple choice questions on this topic.

Forearm amputations form a part of the larger umbrella of upper extremity amputations, but are the most common type, and can occur at different levels from elbow to wrist.[1] The most common cause is trauma, infection, vascular disease, and malignancy.[2] The mechanism of trauma in civilians is primarily industrial crush injuries and in the military both direct combat injury and indirect explosives.[3] Acceptance of prosthesis and performing a transradial amputation rather than more proximal, are crucial to improving outcomes.[4] Also, multidisciplinary efforts can improve the outcomes, from proper and early prosthetic fitting to allow early return to activities of daily living (ADLs)[5], to psychological therapy in helping to overcome the trauma, to physiotherapy and occupational therapy in adapting to life with a prosthesis.

Complications in forearm amputations are much lower than those of the lower limb. Common complications pertain to edema, local infection, wound breakdown, and failure of grafts. These are infrequent but must be recognized. More specifically, phantom limb pain occurs in the majority of upper limb amputees. This is defined as the patient's awareness of the amputated portion of the limb.[11][12]The incidence has been quoted between 40% to 80%. It is a complex condition requiring multiple treatment modalities to overcome.[13] Hematomas can form postoperatively if bleeding is not controlled appropriately. Meticulous hemostasis and use of drain can reduce the chance of hematoma formation. Regardless of the technique employed to divide peripheral nerves, a neuroma always forms. Joint contractures usually are prevented by immediate postoperative active motion. If contractures develop, more aggressive physical therapy is required. Revision surgery is a common complication, as trauma is the most common indication. A study in Iraq and Afghanistan soldiers showed that 42% of upper extremity amputees required a repeat surgical procedure, and those with forearm amputations were 4.7 times more likely to develop phantom limb pain.[14] Finally, psychological stress must not be overlooked. Tintle et al. found that upper-limb amputations have far higher rates of post-traumatic stress disorder (PTSD) and disability than those with lower-limb amputations.[14] Tennent et al. outlined the higher rates of disability that occurs in an active population which under upper-limb amputation, including the significant effects of psychological distress.[15]

Due to the complex procedural nature and unmeasurable morbidity inflicted upon a patient, as outlined above, a multi-specialty approach is vital in ensuring the best outcomes. The first port of call would be stabilizing a traumatic patient in the emergency room by a casualty provider. Due to the unpredictable nature of injuries, a variety of surgical specialties can be utilized to offer the best management – be it free flaps from plastics, revascularization of arteries by vascular surgeons, or optimizing musculoskeletal tissue by orthopedic surgeons to ensure best prosthesis fit and function. Therefore, these injuries should be managed at tertiary units with multi-specialty input. Post-operatively, to minimize patient morbidity, they must be managed holistically. These injuries take months, if not years, to recover. It can only be done through rehabilitation teams, nursing staff, and psychiatric or counseling teams. This interprofessional approach leads to better outcomes and has also been shown to decrease patient stay by 20 days while increasing discharges of patients with a prosthesis by five times and increasing the effectiveness of long-term rehabilitation.[16] [Level 3]