RESUMEN
Partial hand amputations (PHAs) are often associated with detriments to self-expression, independence, and employment. Modern partial hand prostheses, coupled with reconstructive surgery, may greatly mitigate the physical, psychological, social, and financial impairments caused by PHAs. The MCPDriver is a body-powered prosthesis and is an example of one of these modern, easy-to-use prostheses. This case report describes a 30-year-old man who experienced a traumatic, nonreplantable four finger degloving amputation of digits 2-5 at the level of the proximal phalanges. Initial reconstruction included preserving the length of the amputated phalanges and using a pedicled groin flap for soft tissue coverage with the goal to ultimately facilitate the use of a partial hand prosthesis. Once the PHA was stable, the multidisciplinary hand team held several discussions to review how to revise the flap for an MCPDriver. Staged debulking surgeries and syndactyly releases facilitated a successful fitting with the prosthesis. The patient resumed employment and bimanual tasks shortly after being fit with the prosthesis. The patient also reported significant improvements in his mental health and in the quality of his social interactions. This case illustrates how reconstructive surgeries coupled with partial hand prosthesis utilization can restore form and function following amputation. Familiarity with the modern classes of upper extremity prostheses and collaborating within a multidisciplinary hand team will likely enhance reconstructive outcomes following traumatic PHAs.
RESUMEN
Intact tropical forests, free from substantial anthropogenic influence, store and sequester large amounts of atmospheric carbon but are currently neglected in international climate policy. We show that between 2000 and 2013, direct clearance of intact tropical forest areas accounted for 3.2% of gross carbon emissions from all deforestation across the pantropics. However, full carbon accounting requires the consideration of forgone carbon sequestration, selective logging, edge effects, and defaunation. When these factors were considered, the net carbon impact resulting from intact tropical forest loss between 2000 and 2013 increased by a factor of 6 (626%), from 0.34 (0.37 to 0.21) to 2.12 (2.85 to 1.00) petagrams of carbon (equivalent to approximately 2 years of global land use change emissions). The climate mitigation value of conserving the 549 million ha of tropical forest that remains intact is therefore significant but will soon dwindle if their rate of loss continues to accelerate.
