Amputations

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Amputation is the surgical removal of all or part of a limb or extremity such as an arm, leg, foot, hand, toe, or finger. It can also be considered a loss of a limb because of a traumatic event. Surgical amputation is used to control pain or a disease progression in the affected limb. In some cases, it is carried out on individuals as a preventative surgery for such problems. About 1.8 million Americans are living with amputations, most of which are on the leg.

There are many reasons for a surgical amputation. The most common is poor circulation of blood because of the damage or narrowing of arteries, known as peripheral arterial disease caused mainly by diseases such as diabetes. Without adequate blood flow, the body’s cells cannot get oxygen and nutrients they need from the bloodstream. As a result, these cells and tissues begin to die and infection sets in. In addition, the need for amputation can also be caused by a a cancerous tumor in the bone or muscle of the limb or a serious infectious disease that might spread to other parts of the body which cannot be cured by medicine. Lastly, a thickening or nerve tissue as well as frostbite might also require amputations.

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Traumatic amputation is uncommon among us however is very dangerous and painful because the loss of the limb happens immediately after the accident and can cause medical complications. The most common causes of traumatic amputations are

  • Traffic accidents
  • Labor accidents
  • Animal attacks
  • Firearms/explosives

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An amputation usually requires a hospital stay of five to 14 days or more, depending on the surgery and complications. Amputation is done under general anesthesia (meaning the patient is asleep). When performing an amputation, the surgeon removes all damaged tissue while leaving as much healthy tissue as possible. A doctor may use several methods to determine where to cut such as checking for a pulse close to where the surgeon is planning to cut, comparing skin temperatures of the affected limb with those of a healthy limb, and looking for areas of reddened skin. During the procedure itself the surgeon will take many preventative measures and perform the surgery, The steps are

  1. Remove the diseased tissue and any crushed bone
  2. Smooth uneven areas of bone
  3. Seal off blood vessels and nerves
  4. Cut and shape muscles so that the stump, or end of the limb will be able to artificial limb attached to it.

Then the surgeon will eventually close the wound by sewing the skin flaps. After that they cover the wound with a rigid removable dressing (RRD) and may place a stocking over the stump to hold the bandage dressing. These RRD’s have been shown to improve healing time, reduce edema(accumulation of fluids in certain tissues within the body), and reduce complications.

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Majority of the time, after a patient loses a limb he/she will want a prosthetic. However, it is not possible to attach a prosthetic immediately after surgery because the muscles will still be tender and loose. This is why a patient is usually sent into rehabilitation during the acute treatment phase to run through exercises that will stiffen up their bones and ensure the return to the highest level of function and independence possible and set them up so that a prosthetic can be attached. In addition, it also helps maximize the patient’s capabilities at home and in the community by improving self-esteem and the patient’s ability to self-care. Rehab programs include:

  • Treatments to help improve wound healing and stump care
  • Activities to help improve motor skills, restore activities of daily living (ADLs), and help the patient reach maximum independence
  • Exercises that promote muscle strength, endurance, and control
  • Pain management for both postoperative and phantom pain (a sensation of pain that occurs below the level of the amputation)Image result for amputation rehabilitation exercises

Overall, the goal of both physical and mental rehabilitation is to help the patient return to the highest level of function and independence possible, while improving the overall quality of life — physically, emotionally, and socially.

-Smaran Sivashankar

Sources: https://medlineplus.gov/limbloss.html

https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/amputation

https://www.webmd.com/a-to-z-guides/definition-amputation#2

 

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