Amputation

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Amputation_table_infobox_0

AmputationAmputation_header_cell_0_0_0
SpecialtyAmputation_header_cell_0_1_0 Surgery

Physical medicine and rehabilitation

Emergency medicineAmputation_cell_0_1_1

Amputation is the removal of a limb by trauma, medical illness, or surgery. Amputation_sentence_0

As a surgical measure, it is used to control pain or a disease process in the affected limb, such as malignancy or gangrene. Amputation_sentence_1

In some cases, it is carried out on individuals as a preventive surgery for such problems. Amputation_sentence_2

A special case is that of congenital amputation, a congenital disorder, where fetal limbs have been cut off by constrictive bands. Amputation_sentence_3

In some countries, most notably the United States, amputation of the hands, feet or other body parts is or was used as a form of punishment for people who committed crimes. Amputation_sentence_4

Amputation has also been used as a tactic in war and acts of terrorism; it may also occur as a war injury. Amputation_sentence_5

In some cultures and religions, minor amputations or mutilations are considered a ritual accomplishment. Amputation_sentence_6

When done by a person, the person executing the amputation is an amputator. Amputation_sentence_7

The amputated person is called an amputee. Amputation_sentence_8

In the US, the majority of new amputations occur due to complications of the vascular system (the blood vessels), especially from diabetes. Amputation_sentence_9

Between 1988 and 1996, there were an average of 133,735 hospital discharges for amputation per year in the US. Amputation_sentence_10

In 2005, just in the US, there were 1.6 million amputees. Amputation_sentence_11

In 2013, the US has 2.1 million amputees. Amputation_sentence_12

Approximately 185,000 amputations occur in the United States each year. Amputation_sentence_13

In 2009, hospital costs associated with amputation totaled more than $8.3 billion. Amputation_sentence_14

There will be an estimated 3.6 million people in the US living with limb loss by 2050. Amputation_sentence_15

African Americans are up to four times more likely to have an amputation than European Americans. Amputation_sentence_16

Types Amputation_section_0

Leg Amputation_section_1

Lower limb amputations can be divided into two broad categories: minor and major amputations. Amputation_sentence_17

Minor amputations generally refer to the amputation of digits. Amputation_sentence_18

Major amputations are commonly below-knee- or above-knee amputations. Amputation_sentence_19

Common partial foot amputations include the Chopart, Lisfranc, and ray amputations. Amputation_sentence_20

Common forms of ankle disarticulations include Pyrogoff, Boyd, and Syme amputations. Amputation_sentence_21

A less common major amputation is the Van Nes rotation, or rotationplasty, i.e. the turning around and reattachment of the foot to allow the ankle joint to take over the function of the knee. Amputation_sentence_22

Types of amputations include: Amputation_sentence_23

Amputation_description_list_0

  • partial foot amputation: amputation of the lower limb distal to the ankle jointAmputation_item_0_0
  • ankle disarticulation: amputation of the lower limb at the ankle jointAmputation_item_0_1
  • trans-tibial amputation: amputation of the lower limb between the knee joint and the ankle joint, commonly referred to as a below-knee amputationAmputation_item_0_2
  • knee disarticulation: amputation of the lower limb at the knee jointAmputation_item_0_3
  • trans-femoral amputation: amputation of the lower limb between the hip joint and the knee joint, commonly referred to an above-knee amputationAmputation_item_0_4
  • hip disarticulation: amputation of the lower limb at the hip jointAmputation_item_0_5
  • trans-pelvic disarticulation: amputation of the whole lower limb together with all or part of the pelvis, also known as a hemipelvectomy or hindquarter amputationAmputation_item_0_6

Arm Amputation_section_2

Types of upper extremity amputations include: Amputation_sentence_24

Amputation_unordered_list_1

  • partial hand amputationAmputation_item_1_7
  • wrist disarticulationAmputation_item_1_8
  • trans-radial amputation, commonly referred to as below-elbow or forearm amputationAmputation_item_1_9
  • elbow disarticulationAmputation_item_1_10
  • trans-humeral amputation, commonly referred to as above-elbow amputationAmputation_item_1_11
  • shoulder disarticulationAmputation_item_1_12
  • forequarter amputationAmputation_item_1_13

A variant of the trans-radial amputation is the Krukenberg procedure in which the radius and ulna are used to create a stump capable of a pincer action. Amputation_sentence_25

Other Amputation_section_3

Self-amputation Amputation_section_4

See also: Autotomy and Body integrity identity disorder Amputation_sentence_26

In some rare cases when a person has become trapped in a deserted place, with no means of communication or hope of rescue, the victim has amputated his or her own limb. Amputation_sentence_27

The most notable case of this is Aron Ralston, a hiker who amputated his own right forearm after it was pinned by a boulder in a hiking accident and he was unable to free himself for over five days. Amputation_sentence_28

Body integrity identity disorder is a psychological condition in which an individual feels compelled to remove one or more of their body parts, usually a limb. Amputation_sentence_29

In some cases, that individual may take drastic measures to remove the offending appendages, either by causing irreparable damage to the limb so that medical intervention cannot save the limb, or by causing the limb to be severed. Amputation_sentence_30

Causes Amputation_section_5

Circulatory disorders Amputation_section_6

Amputation_unordered_list_2

Neoplasm Amputation_section_7

Amputation_unordered_list_3

Trauma Amputation_section_8

Amputation_unordered_list_4

  • Severe limb injuries in which the limb cannot be saved or efforts to save the limb fail.Amputation_item_4_18
  • Traumatic amputation (an unexpected amputation that occurs at the scene of an accident, where the limb is partially or entirely severed as a direct result of the accident, for example, a finger that is severed from the blade of a table saw)Amputation_item_4_19
  • Amputation in utero (Amniotic band)Amputation_item_4_20

Congenital anomalies Amputation_section_9

Amputation_unordered_list_5

Infection Amputation_section_10

Amputation_unordered_list_6

Frostbite Amputation_section_11

Frostbite, also known as frostnip, happens when the individual's skin is exposed to cold weather for too long. Amputation_sentence_31

The fluid in the pale skin solidifies, creating ice crystals, leading to swelling and severe pain. Amputation_sentence_32

Other symptoms can include numbness, confusion, dizziness, fatigue, nausea, stiffness in the muscles or joints as well as difficulty walking. Amputation_sentence_33

If the frostbite doesn't get treated soon, this process results in hypothermia, death or poisoning of the bloodstream. Amputation_sentence_34

This can affect the hands, feet, toes, fingers, eyes, and face. Amputation_sentence_35

Once the frostbite shuts the eyelids, this is known as snow blindness. Amputation_sentence_36

The only way to stop it from spreading is through skin grafts or amputation. Amputation_sentence_37

Athletic performance Amputation_section_12

Sometimes professional athletes may choose to have a non-essential digit amputated to relieve chronic pain and impaired performance. Amputation_sentence_38

Amputation_unordered_list_7

Surgery Amputation_section_13

Method Amputation_section_14

Post-operative management Amputation_section_15

A 2019 Cochrane systematic review aimed to determine whether rigid dressings were more effective than soft dressings in helping wounds heal following transtibial (below the knee) amputations. Amputation_sentence_39

Due to the limited and very low certainty evidence available, the authors concluded that it was uncertain what the benefits and harms were for each dressing type. Amputation_sentence_40

They recommended that clinicians consider the pros and cons of each dressing type on a case-by-case basis e.g. rigid dressings may potentially benefit patients who have a high risk of falls and soft dressings may potentially benefit patients who have poor skin integrity. Amputation_sentence_41

A 2017 review found that the use of rigid removable dressings (RRD's) in trans-tibial amputations, rather than soft bandaging, improved healing time, reduced edema, prevented knee flexion contractures and reduced complications, including further amputation, from external trauma such as falls onto the stump. Amputation_sentence_42

Post-operative management, in addition to wound healing, should consider maintenance of limb strength, joint range, edema management, preservation of the intact limb (if applicable) and stump desensitisation. Amputation_sentence_43

Trauma Amputation_section_16

Traumatic amputation is the partial or total avulsion of a part of a body during a serious accident, like traffic, labor, or combat. Amputation_sentence_44

Traumatic amputation of a human limb, either partial or total, creates the immediate danger of death from blood loss. Amputation_sentence_45

Orthopedic surgeons often assess the severity of different injuries using the Mangled Extremity Severity Score. Amputation_sentence_46

Given different clinical and situational factors, they can predict the likelihood of amputation. Amputation_sentence_47

This is especially useful for emergency physicians to quickly evaluate patients and decide on consultations. Amputation_sentence_48

Causes Amputation_section_17

Traumatic amputation is uncommon in humans (1 per 20,804 population per year). Amputation_sentence_49

Loss of limb usually happens immediately during the accident, but sometimes a few days later after medical complications. Amputation_sentence_50

Statistically, the most common causes of traumatic amputations are: Amputation_sentence_51

Amputation_unordered_list_8

  • Traffic accidents (cars, motorcycles, bicycles, trains, etc.)Amputation_item_8_40
  • Labor accidents (equipment, instruments, cylinders, chainsaws, press machines, meat machines, wood machines, etc.)Amputation_item_8_41
  • Agricultural accidents, with machines and mower equipmentAmputation_item_8_42
  • Electric shock hazardsAmputation_item_8_43
  • Firearms, bladed weapons, explosivesAmputation_item_8_44
  • Violent rupture of ship rope or industry wire ropeAmputation_item_8_45
  • Ring traction (ring amputation, de-gloving injuries)Amputation_item_8_46
  • Building doors and car doorsAmputation_item_8_47
  • Animal attacksAmputation_item_8_48
  • Gas cylinder explosionsAmputation_item_8_49
  • Other rare accidentsAmputation_item_8_50

Treatment Amputation_section_18

The development of the science of microsurgery over the last 40 years has provided several treatment options for a traumatic amputation, depending on the patient's specific trauma and clinical situation: Amputation_sentence_52

Amputation_unordered_list_9

  • 1st choice: Surgical amputation - break - prosthesisAmputation_item_9_51
  • 2nd choice: Surgical amputation - transplantation of other tissue - plastic reconstruction.Amputation_item_9_52
  • 3rd choice: Replantation - reconnection - revascularisation of amputated limb, by microscope (after 1969)Amputation_item_9_53
  • 4th choice: Transplantation of cadaveric hand (after 2000),Amputation_item_9_54

Epidemiology Amputation_section_19

Amputation_unordered_list_10

  • In the United States in 1999, there were 14,420 non-fatal traumatic amputations according to the American Statistical Association. Of these, 4,435 occurred as a result of traffic and transportation accidents and 9,985 were due to labor accidents. Of all traumatic amputations, the distribution percentage is 30.75% for traffic accidents and 69.24% for labor accidents.Amputation_item_10_55
  • The population of the United States in 1999 was about 300,000,000, so the conclusion is that there is one amputation per 20,804 persons per year. In the group of labor amputations, 53% occurred in laborers and technicians, 30% in production and service workers, 16% in silviculture and fishery workers.Amputation_item_10_56
  • A study found that in 2010, 22.8% of patients undergoing amputation of a lower extremity in the United States were readmitted to the hospital within 30 days.Amputation_item_10_57

Prevention Amputation_section_20

Methods in preventing amputation, limb-sparing techniques, depend on the problems that might cause amputations to be necessary. Amputation_sentence_53

Chronic infections, often caused by diabetes or decubitus ulcers in bedridden patients, are common causes of infections that lead to gangrene, which would then necessitate amputation. Amputation_sentence_54

There are two key challenges: first, many patients have impaired circulation in their extremities, and second, they have difficulty curing infections in limbs with poor vasculation (blood circulation). Amputation_sentence_55

Crush injuries where there is extensive tissue damage and poor circulation also benefit from hyperbaric oxygen therapy (HBOT). Amputation_sentence_56

The high level of oxygenation and revascularization speed up recovery times and prevent infections. Amputation_sentence_57

A study found that the patented method called Circulator Boot achieved significant results in prevention of amputation in patients with diabetes and arteriosclerosis. Amputation_sentence_58

Another study found it also effective for healing limb ulcers caused by peripheral vascular disease. Amputation_sentence_59

The boot checks the heart rhythm and compresses the limb between heartbeats; the compression helps cure the wounds in the walls of veins and arteries, and helps to push the blood back to the heart. Amputation_sentence_60

For victims of trauma, advances in microsurgery in the 1970s have made replantations of severed body parts possible. Amputation_sentence_61

The establishment of laws, rules, and guidelines, and employment of modern equipment help protect people from traumatic amputations. Amputation_sentence_62

Prognosis Amputation_section_21

The individual may experience psychological trauma and emotional discomfort. Amputation_sentence_63

The stump will remain an area of reduced mechanical stability. Amputation_sentence_64

Limb loss can present significant or even drastic practical limitations. Amputation_sentence_65

A large proportion of amputees (50–80%) experience the phenomenon of phantom limbs; they feel body parts that are no longer there. Amputation_sentence_66

These limbs can itch, ache, burn, feel tense, dry or wet, locked in or trapped or they can feel as if they are moving. Amputation_sentence_67

Some scientists believe it has to do with a kind of neural map that the brain has of the body, which sends information to the rest of the brain about limbs regardless of their existence. Amputation_sentence_68

Phantom sensations and phantom pain may also occur after the removal of body parts other than the limbs, e.g. after amputation of the breast, extraction of a tooth (phantom tooth pain) or removal of an eye (phantom eye syndrome). Amputation_sentence_69

A similar phenomenon is unexplained sensation in a body part unrelated to the amputated limb. Amputation_sentence_70

It has been hypothesized that the portion of the brain responsible for processing stimulation from amputated limbs, being deprived of input, expands into the surrounding brain, (Phantoms in the Brain: V.S. Amputation_sentence_71 Ramachandran and Sandra Blakeslee) such that an individual who has had an arm amputated will experience unexplained pressure or movement on his face or head. Amputation_sentence_72

In many cases, the phantom limb aids in adaptation to a prosthesis, as it permits the person to experience proprioception of the prosthetic limb. Amputation_sentence_73

To support improved resistance or usability, comfort or healing, some type of stump socks may be worn instead of or as part of wearing a prosthesis. Amputation_sentence_74

Another side effect can be heterotopic ossification, especially when a bone injury is combined with a head injury. Amputation_sentence_75

The brain signals the bone to grow instead of scar tissue to form, and nodules and other growth can interfere with prosthetics and sometimes require further operations. Amputation_sentence_76

This type of injury has been especially common among soldiers wounded by improvised explosive devices in the Iraq War. Amputation_sentence_77

Due to technologic advances in prosthetics, many amputees live active lives with little restriction. Amputation_sentence_78

Organizations such as the Challenged Athletes Foundation have been developed to give amputees the opportunity to be involved in athletics and adaptive sports such as Amputee Soccer. Amputation_sentence_79

Nearly half of the individuals who have an amputation due to vascular disease will die within 5 years, usually secondary to the extensive co-morbidities rather than due to direct consequences of amputation. Amputation_sentence_80

This is higher than the five year mortality rates for breast cancer, colon cancer, and prostate cancer. Amputation_sentence_81

Of persons with diabetes who have a lower extremity amputation, up to 55% will require amputation of the second leg within two to three years. Amputation_sentence_82

Etymology Amputation_section_22

The word amputation is derived from the Latin amputare, "to cut away", from ambi- ("about", "around") and putare ("to prune"). Amputation_sentence_83

The English word “Poes” was first applied to surgery in the 17th century, possibly first in Peter Lowe's A discourse of the Whole Art of Chirurgerie (published in either 1597 or 1612); his work was derived from 16th-century French texts and early English writers also used the words "extirpation" (16th-century French texts tended to use extirper), "disarticulation", and "dismemberment" (from the Old French desmembrer and a more common term before the 17th century for limb loss or removal), or simply "cutting", but by the end of the 17th century "amputation" had come to dominate as the accepted medical term. Amputation_sentence_84

Notable cases Amputation_section_23

Amputation_unordered_list_11

See also Amputation_section_24

Amputation_unordered_list_12


Credits to the contents of this page go to the authors of the corresponding Wikipedia page: en.wikipedia.org/wiki/Amputation.