Function Versus Aesthetic: Arm Reconstruction After Land Mine Explosion
Tragically, land mines injure between 15,000 to 20,000 people each year. Some civilians see a metal object sticking out of the ground and attempt to pick it up and inspect it - the result is often loss of both hands and eyes.
The goal of rehabilitation after trauma is to restore as much independence as possible to patients. With loss of vision and no hands, self care, feeding, and donning/doffing arm prostheses can be very challenging. There is a procedure, known as the Krukenberg operation (named after Hermann Von Krukenberg, who first described it in 1917), that allows the forearm bones to be separated, using the muscle rotators that exist between them to create a pincer grasp. This procedure is not uncommonly used in India and Pakistan and does indeed return some degree of functional use to the arms.
At a recent Physical Medicine and Rehabilitation conference, this photograph was used to illustrate arm function after the Krukenberg operation.
Photo Credit: Dr. Heikki Uustal
It certainly presents a conundrum - should function trump aesthetics in all cases?
I’m not sure that I’d want this procedure, even if I lost my vision and both hands.
Would you?
The question “would you?” is so wonderfully naive. Most of the “accidents” that result in these bilateral (both sides) hand amputations are a result of explosive remnants of war (ERW), landmines being the biggest culprit, and children are often victims. Have you noticed, few ERWs found in this country? Most are in underdeveloped regions of the world, where fancy prosthetics are hard to come by, to say nothing about the ability to repair and replace the prosthetics for wear 'n' tear or growth. Furthermore, children often find upper extremity prosthetics to be cumbersome, heavy and hot, and even though they may impart functionality, in reality, the children will often stop wearing them. Quickly, these children become a burden to society, rather than a rehabilitatable asset. That is why this is a frequently used procedure in India, for example. It is also possible to fit the patient with a cosmetic prosthesis, so as not to attract stares. What we as an educated society can do is stop stigmatizing such a useful procedure. Heck, while we're at it, let's ban landmines, and better fund their removal of the 100 million still hidden across our earth.
The question “would you?” is so wonderfully naive. Most of the “accidents” that result in these bilateral (both sides) hand amputations are a result of explosive remnants of war (ERW), landmines being the biggest culprit, and children are often victims. Have you noticed, few ERWs found in this country? Most are in underdeveloped regions of the world, where fancy prosthetics are hard to come by, to say nothing about the ability to repair and replace the prosthetics for wear 'n' tear or growth. Furthermore, children often find upper extremity prosthetics to be cumbersome, heavy and hot, and even though they may impart functionality, in reality, the children will often stop wearing them. Quickly, these children become a burden to society, rather than a rehabilitatable asset. That is why this is a frequently used procedure in India, for example. It is also possible to fit the patient with a cosmetic prosthesis, so as not to attract stares. What we as an educated society can do is stop stigmatizing such a useful procedure. Heck, while we're at it, let's ban landmines, and better fund their removal of the 100 million still hidden across our earth.