Transhumeral Amputation, Surgical Approach, Technique, Steps, Prosthesis, and Right/Left Side

Transhumeral Amputation:

• What is Transhumeral Amputation?
• Surgical Approach
• Technique
• Steps
• Prosthesis
• Right/Left Side Considerations

What is Transhumeral Amputation?

Transhumeral amputation is a surgical procedure in which the upper limb is amputated through the humerus, above the elbow joint and below the shoulder. This level of amputation removes the forearm, elbow, wrist, and hand while preserving a portion of the upper arm. It is most commonly performed due to severe trauma, malignant tumors, uncontrollable infection, vascular compromise, or non-salvageable limb injuries.

From a functional standpoint, transhumeral amputation presents unique rehabilitation challenges because the elbow joint is lost. However, preserving adequate humeral length is critical, as it improves prosthetic fitting, control, and overall upper-limb function. Modern surgical techniques and advanced prosthetic technology have significantly improved outcomes, allowing many patients to regain independence in daily activities.

Surgical Approach

The surgical approach for transhumeral amputation focuses on preserving viable tissue, maintaining muscle balance, and creating a pain-free, prosthesis-friendly residual limb. The surgeon carefully plans skin flaps to ensure adequate coverage while avoiding excessive tension. Common approaches include anterior-posterior or equal-length flap designs, depending on soft tissue availability and the underlying pathology.

Major neurovascular structures such as the brachial artery, median nerve, ulnar nerve, and radial nerve are carefully identified and managed. Nerves are gently pulled down, transected under tension, and allowed to retract to reduce neuroma formation. Proper hemostasis and atraumatic handling of tissues are essential to prevent complications and support long-term prosthetic use.

Technique

The surgical technique emphasizes atraumatic dissection and precise bone handling. After flap creation and muscle separation, the humerus is exposed and transected at the predetermined level. The bone edges are smoothed and beveled to prevent pressure points. Muscles are then stabilized using myodesis or myoplasty to maintain balance and provide padding over the bone.

Special attention is given to nerve handling to minimize phantom limb pain and neuroma development. Modern techniques may include targeted muscle reinnervation (TMR) to improve prosthetic control and reduce post-amputation pain. Proper wound closure with drains ensures reduced hematoma formation and promotes faster healing.

Steps

The key steps of transhumeral amputation include preoperative marking, skin flap creation, identification of neurovascular bundles, and controlled muscle division. The humerus is then cut at the appropriate level, ensuring maximal length preservation while removing diseased tissue.

Following bone preparation, muscles are reattached using myodesis or myoplasty. Nerves are managed carefully, and the wound is irrigated and closed in layers. A compression dressing or rigid removable dressing may be applied postoperatively to control swelling and shape the residual limb for prosthetic fitting.

Prosthesis

Prosthetic options after transhumeral amputation include body-powered, myoelectric, and hybrid prostheses. These devices often incorporate an artificial elbow joint, allowing flexion and extension for functional reach. Myoelectric prostheses use electrical signals from residual muscles to control movement, offering improved dexterity and cosmetic appearance.

Successful prosthetic use depends on residual limb length, muscle control, skin integrity, and rehabilitation support. Early prosthetic training, physical therapy, and occupational therapy play vital roles in helping patients adapt. Advances in prosthetic technology continue to enhance functional outcomes and quality of life.

Right/Left Side Considerations

Right- or left-sided transhumeral amputation has functional implications depending on hand dominance. Loss of the dominant arm often presents greater challenges in performing daily activities, writing, and occupational tasks. Rehabilitation programs are tailored to address these challenges and retrain the non-dominant hand if needed.

From a surgical perspective, the principles remain the same for both sides, but prosthetic customization and therapy goals may differ. Occupational demands, lifestyle, and patient preferences are carefully considered to optimize functional recovery and independence regardless of the side affected.