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Sci-Tech Dictionary:

amputation

(′am·pyə′tā·shən)

(medicine) The surgical, congenital, or spontaneous removal of a limb or projecting body part.

 
 
Surgery Encyclopedia: Amputation

Definition

Amputation is the surgical removal of a limb or body part. It is performed to remove diseased tissue or relieve pain.

Purpose

Arms, legs, hands, feet, fingers, and toes can all be amputated. In the United States, there are approximately

In an above-the-knee amputation, three incisions are made (A). First the skin and muscle layers are cut (B). The major blood vessels are clamped and severed (C). The bone is cut with a special saw (D). Finally, the muscles are stitched over the bone, and the skin is closed over the wound (E). (Illustration by GGS Inc.)

In an above-the-knee amputation, three incisions are made (A). First the skin and muscle layers are cut (B). The major blood vessels are clamped and severed (C). The bone is cut with a special saw (D). Finally, the muscles are stitched over the bone, and the skin is closed over the wound (E). (Illustration by GGS Inc.)

350,000 amputees, with some 135,000 new amputations occurring each year. The number of amputees worldwide is not currently known.

Here in the United States, the most common causes of amputation of the lower extremity are: disease (70%), trauma (22%), congenital or birth defects (4%), and tumors (4%). As for upper extremity amputation, it is usually performed because of trauma or birth defect. Seldom is disease as great a contributing factor. The causes of amputation differ significantly in various countries. For example, countries with a recent history of warfare and civil unrest will have a higher incidence of amputations, due to war itself or its technology (landmines, uncontrolled ordnance, etc).

Among the diseases and conditions that may lead to amputation of an extremity, the most prevalent are:

  • hardening of the arteries
  • arterial embolism
  • impaired circulation as a complication of diabetes mellitus
  • gangrene
  • severe frostbite
  • Raynaud's disease
  • Buerger's disease

More than 90% of amputations performed in the United States are due to circulatory complications of diabetes. Sixty to eighty percent of these operations involve the legs.

Demographics

Most amputations involve small body parts such as a finger, rather than an entire limb. About 65,000 amputations are performed in the United States each year.

In the United States, there are approximately 350,000 amputees, with some 135,000 new amputations occurring each year. The number of amputees worldwide is not currently known.

Description

Amputations can be either planned or emergency procedures. Injury and arterial embolisms are the main reasons for emergency amputations. The operation is performed under regional or general anesthesia by a general or orthopedic surgeon in a hospital operating room.

Details of the operation vary slightly depending on what part is to be removed. All amputations consist of a two-fold surgical procedure: to remove diseased tissue so that the wound will heal cleanly, and to construct a stump that will allow the attachment of a prosthesis or artificial replacement part.

The surgeon makes an incision around the part to be amputated. The part is removed, and the bone is smoothed. A flap is constructed of muscle, connective tissue, and skin to cover the raw end of the bone. The flap is closed over the bone with sutures (surgical stitches) that remain in place for about one month. Often, a rigid dressing or cast is applied that stays in place for about two weeks.

Diagnosis/Preparation

Before an amputation is performed, extensive testing is done to determine the proper level of amputation. The goal of the surgeon is to find the place where healing is most likely to be complete, while allowing the maximum amount of limb to remain for effective rehabilitation.

The greater the blood flow through an area, the more likely healing is to occur. These tests are designed to measure blood flow through the limb. Several or all of them can be done to help choose the proper level of amputation.

  • measurement of blood pressure in different parts of the limb
  • xenon 133 studies, which use a radiopharmaceutical to measure blood flow
  • oxygen tension measurements in which an oxygen electrode is used to measure oxygen pressure under the skin (If the pressure is 0, the healing will not occur. If the pressure reads higher than 40mm Hg [40 milliliters of mercury], healing of the area is likely to be satisfactory.)
  • laser doppler measurements of the microcirculation of the skin
  • skin fluorescent studies that also measure skin microcirculation
  • skin perfusion measurements using a blood pressure cuff and photoelectric detector
  • infrared measurements of skin temperature

No one test is highly predictive of healing, but taken together, the results give the surgeon an excellent idea of the best place to amputate.

Aftercare

After amputation, medication is prescribed for pain, and patients are treated with antibiotics to discourage infection. The stump is moved often to encourage good circulation. Physical therapy and rehabilitation are started as soon as possible, usually within 48 hours. Studies have shown that there is a positive relationship between early rehabilitation and effective functioning of the stump and prosthesis. Length of stay in the hospital depends on the severity of the amputation and the general health of the amputee, but ranges from several days to two weeks.

Rehabilitation is a long, arduous process, especially for above the knee amputees. Twice daily physical therapy is not uncommon. In addition, psychological counseling is an important part of rehabilitation. Many people feel a sense of loss and grief when they lose a body part. Others are bothered by phantom limb syndrome, where they feel as if the amputated part is still in place. They may even feel pain in this limb that does not exist. Many amputees benefit from joining self-help groups and meeting others who are also living with amputation. Addressing the emotional aspects of amputation often speeds the physical rehabilitation process.

Risks

Amputation is major surgery. All the risks associated with the administration of anesthesia exist, along with the possibility of heavy blood loss and the development of blood clots. Infection is of special concern to amputees. Infection rates in amputations average 15%. If the stump becomes infected, it is necessary to remove the prosthesis and sometimes to amputate a second time at a higher level.

Failure of the stump to heal is another major complication. Nonhealing is usually due to an inadequate blood supply. The rate of nonhealing varies from 5–30% depending on the facility. Centers that specialize in amputation usually have the lowest rates of complication.

Persistent pain in the stump or pain in the phantom limb is experienced by most amputees to some degree. Treatment of phantom limb pain is difficult. One final complication is that many amputees give up on the rehabilitation process and discard their prosthesis. Better fitting prosthetics and earlier rehabilitation have decreased the incidence of this problem.

Normal Results

The five year survival rate for all lower extremity amputees is less than 50%. For diabetic amputees, the rate is less than 40%. Up to 50% of people who have one leg amputated because of diabetes will lose the other within five years. Amputees who walk using a prosthesis have a less stable gait. Three to five percent of these people fall and break bones because of this instability. Although the fractures can be treated, about half the amputees who suffer them then remain wheelchair bound.

Alternatives

Alternatives to amputation depend on the medical cause underlying the decision to amputate and the degree of medical urgency. In some cases, drug therapy may be considered as an alternative.

For example, one serious complication of diabetes is the development of foot ulcers that often lead to amputation. Some studies have suggested non-surgical treatment of diabetic foot ulcers with a new, recombinant drug (Becaplermin/Regranex). Combined with competent ulcer nursing, the drug leads to fewer amputations compared to the alternative of ulcer nursing on its own.

Resources

Books

Meier, R. H. Functional Restoration of Adults and ChildrenWith Upper Extremity Amputation. New York: Demos Medical Publishing, 2003.

Murdoch, G. and A. Bennett Wilson. A Primer on Amputations and Artificial Limbs. Springfield: Charles C. Thomas Pub. Ltd., 1998.

Watts, H. and M. Williams. Who Is Amelia?: Caring for Children With Limb Difference. Rosemont, IL: American Academy of Orthopaedic Surgeons, 1998.

Periodicals

Buzato, M. A., E. C. Tribulatto, S. M. Costa, W G. Zorn, and B. van Bellen. "Major amputations of the lower leg. The patients two years later." Acta Chirurgica Belgica 102 (August 2002): 248–252.

Cull, D. L., S. M. Taylor, S. E. Hamontree, E. M. Langan, B. A. Snyder, T. M. Sullivan, and J. R. Youkey. "A reappraisal of a modified through-knee amputation in patients with peripheral vascular disease." American Journal of Surgery 182 (July 2001): 44–48.

Gerstein, H. and D. Hunt. "Foot ulcers and amputations in diabetes." Clinical Evidence 7 (June 2002): 521–528.

Hagberg, K. and R. Branemark. "Consequences of non-vascular trans-femoral amputation: a survey of quality of life, prosthetic use and problems." Prosthetic Orthotherapy International 25 (December 2001): 186–194.

Kazmers, A., A. J. Perkins and L. A. Jacobs. "Major lower extremity amputation in Veterans Affairs medical centers." Annals of Vascular Surgery 14 (May 2000): 216–222.

Oyibo, S. O., E. B. Jude, I. Tarawneh, H. C. Nguyen, D. G. Armstrong, L. B. Harkless, and A. J. Boulton. "The effects of ulcer size and site, patient's age, sex and type and duration of diabetes on the outcome of diabetic foot ulcers." Diabetic Medicine 18 (February 2001): 133–138.

Organizations

American Academy of Orthopaedic Surgeons. 6300 North River Road, Rosemont, Illinois 60018-4262. Phone (847) 823-7186. www.aaos.org.

American College of Surgeons. 633 N. Saint Clar st., Chicago, IL 60611-3211. (312) 202-5000. www.facs.org.

American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 342-2383. www.diabetes.org.

National Amputation Foundation. 40 Church Street, Malverne, NY 11565. (516) 887-3600. www.nationalamputation.org/.

Other

The Amputee Newswire.http://www.amputee-online.com/amputation/.

Amputation Prevention Global Resource Center Page.www.diabetesresource.com.

Cripworld Guide to Amputation.http://www.cripworld.com/amputee/ampinfo.htm.

— Tish Davidson, A.M. Monique Laberge, Ph.D.

 
Word Tutor: amputation
pronunciation

IN BRIEF: n. - A surgical removal of all or part of a limb; A condition of disability resulting from the loss of one or more limbs.

Tutor's tip: While you may resent the "imputation" that you aren't tough enough for wilderness hiking, you can end up with an "amputation" of frostbitten toes!

 
Wikipedia: amputation
Partial hand amputation
Enlarge
Partial hand amputation

Amputation is the removal of a body extremity by trauma or surgery. As a surgical measure, it is used to control pain or a disease process in the affected limb, such as malignancy or gangrene. In some cases, it is carried out on individuals as a preventative surgery for such problems. A special case is the congenital amputation, a congenital disorder, where foetal limbs have been cut off by constrictive bands. In some countries, amputation of the hands or feet was or is used as a form of punishment for criminals. Amputation has also been used as a tactic in war and acts of terrorism. In some cultures and religions, minor amputations or mutilations are considered a ritual accomplishment. Unlike many non-mammalian animals, (such as lizards which shed their tails), once removed, human extremities do not grow back. A transplant or a prosthesis are the only options for recovering the loss.[1]

History

Origins of the word

Amputation is derived from the Latin amputare, to cut away, from amb (about) and putare (to prune). The Latin word has never been recorded in a surgical context, being reserved to indicate punishment for criminals. The English word amputation 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.

Overview

The history of human amputation can be divided into a number of periods. Initially the many thousands of years when limb loss was the result of trauma or 'nonsurgical' removal. This was followed by the hesitant beginnings of surgical intervention, mainly on gangrenous limbs or those already terribly damaged, which developed through to surgical amputations around the 15th century, the distinction is marked by the choice of the patient and the aim of saving a life and achieving a healed stump, despite the difficulties with infection and the lack of effective control for pain or blood loss. Improvements in surgical techniques were married with better haemorrhage control in the 19th century and in the 1840s with anaesthesia and around twenty years later efficient infection control. The 20th century noted marked improvements in surgical techniques and also a move to increasingly sophisticated prosthetic limbs.

Types

Types of amputation include:

  • leg
    • amputation of digits
    • partial foot amputation (Chopart, Lisfranc)
    • ankle disarticulation (Syme, Pyrogoff)
    • below-knee amputation (transtibial)
    • knee-bearing amputation (knee disarticulation)
    • above knee amputation (transfemoral)
    • Van-ness rotation (Foot being turned around and reattached to allow the ankle joint to be used as a knee.)
    • hip disarticulation
    • hemipelvectomy
  • arm
    • amputation of digits
    • metacarpal amputation
    • wrist disarticulation
    • forearm amputation (transradial)
    • elbow disarticulation
    • above-elbow amputation (transhumeral)
    • shoulder disarticulation and forequarter amputation
    • Krukenberg procedure
  • teeth
    • The avulsion of some teeth (mainly incisives) is or was practiced by some cultures for ritual purposes (for instance in the Iberomaurusian culture of Neolithic North Africa).

Hemicorporectomy, or amputation at the waist, is the most radical amputation.

Genital modification and mutilation may involve amputating tissue (as the case is with circumcision), although not necessarily as a result of injury or disease.

As a rule, partial amputations are preferred to preserve joint function, but in oncological surgery, disarticulation is favored.

Reasons for amputation

  • Cancerous bone tumours (e.g. osteosarcoma, osteochondroma)
  • Severe limb injuries in which the limb cannot be spared or attempts to spare the limb have failed
  • Circulation problems
  • Deformities of digits and/or limbs
  • Any advanced cancers
  • Gangrene
  • Bone infection (osteomyelitis)
  • Traumatic amputation (Amputation occurs actually at scene of accident, the limb can be partially or wholly severed)
  • Amputation in utero (Amniotic band)
  • Sometimes professional athletes may choose to have a non-essential digit amputated to relieve chronic pain and impaired performance. Daniel Chick elected to have his left ring finger amputated as chronic pain and injury was limiting his performance.[2] Rugby union player Jone Tawake also had a finger removed.[3]

Method

Curved knives such as this one were used, in the past, for some kinds of amputations.
Enlarge
Curved knives such as this one were used, in the past, for some kinds of amputations.

The first step is ligating the supplying artery and vein, to prevent hemorrhage. The muscles are transected, and finally the bone is sawed through with an oscillating saw. Skin and muscle flaps are then transposed over the stump, occasionally with the insertion of elements to attach a prosthesis.

Self-amputation

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 own limb:

  • In 2007, 66-year old Al Hill amputated his leg below the knee using his pocketknife after the leg got stuck beneath a felled tree he was cutting in California. [2]
  • In 2003, 27-year old Aron Ralston amputated his forearm using his pocketknife and breaking and tearing the two bones, after the arm got stuck under a boulder when hiking in Utah.
  • Also in 2003, an Australian coal miner amputated his own arm with a Stanley knife after it became trapped when the front-end loader he was driving overturned three kilometers underground. [3]
  • In the 1990s, a crab fisherman got his arm caught in the winch during a storm and had to amputate it at the shoulder, as reported in The New Englander.

Even rarer are cases where self-amputation is performed for criminal or political purposes:

  • Documentary filmmaker Errol Morris was ordered to "leave town within twenty-four hours or leave in a casket" by the unnamed "king of the nubbies" of the town of Vernon, Florida (which Morris called "Nub City"), when he was researching a documentary about a bizarre scam wherein individuals would cut off their own limbs as a way to collect insurance money.[4] The final version of Vernon, Florida contains no references to this scam.
  • On March 7 1998, Daniel Rudolph, the elder brother of the 1996 Olympics bomber Eric Robert Rudolph, videotaped himself cutting off one of his own hands with an electric saw in order to "send a message to the FBI and the media." [5]

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. 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 can not save the limb, or by causing the limb to be severed.

After-effects

A large proportion of amputees (50-80%) experience the phenomenon of phantom limbs;[4] they feel body parts that are no longer there. These limbs can itch, ache, and feel as if they are moving. 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. 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). A similar phenomenon is unexplained sensation in a body part unrelated to the amputated limb. It has been hypothesized that the portion of the brain responsible for processing stimulation from amputated limbs, being deprived of input, actually expands into the surrounding brain, such that an individual who has had an arm amputated will experience unexplained pressure or movement on their face or head. The individual may also experience some trauma as well as emotional discomfort.

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

Another side-effect can be heterotopic ossification, especially when a bone injury is combined with a head injury. 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. This type of injury has been especially common among soldiers wounded by improvised explosive devices in the Iraq war. [6]

References

  1. ^ [1]
  2. ^ RTE: Aussie Rules star has finger removed
  3. ^ SportsAustralia.com: Tawake undergoes surgery to remove finger
  4. ^ Heidi Schultz (January 2005). "Phantom Input". National Geographic Magazine. 

See also

External links

  • Amputation from Cooper's 1835 "Practice of Surgery"
  • The amputee website from the UMC St Radboud Amputee Team
  • OandPCare.org provide information for amputees, their families, the media and the general public on prosthetic care for amputees.
  • amputee website Life goes on as an amputee. Help for amputees and their families.
  • Planet Terror Film featuring a main character who loses her leg.

This entry is from Wikipedia, the leading user-contributed encyclopedia. It may not have been reviewed by professional editors (see full disclaimer)

 
 

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