Amputation is a life-saving procedure involving the surgical removal of a body part. The most common type is below-the-knee amputation. Other types include over-the-knee amputation, lower-extremity amputation, and upper-extremity amputation.
The most common condition necessitating amputation is ischemia (restricted blood supply) from peripheral artery disease — a circulatory condition caused by narrowed blood vessels.
Amputations are only performed when no other options are available to salvage the damaged tissue. During the procedure, the surgeon will make the stump as long as possible to facilitate the use of prosthetics in the future.
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Types of Amputation
Lower Extremity Amputation — Lower limb amputation is used to remove the infection, dead tissue, or localized cancerous tumors, and is sometimes a life-saving operation. Peripheral artery disease, alone or combined with diabetes, accounts for more than half of all amputations; trauma is the second leading cause. The second transatlantic trans-social consensus working group (TASC II) recorded the incidence of major amputations due to peripheral arterial disease, which is 12 to 50 per 100,000 people per year.
Upper Extremity Amputation — Upper limb amputation is most commonly used to treat injuries from trauma. It may also be required to treat malignant tumors or manage refractory pain or genetic deformities. In 2005 more than 500,000 people were living with upper extremity amputation, which accounted for one-third of all amputations.
When is amputation required?
Amputation is required when a limb becomes unsalvageable due to one of many reasons, such as severe trauma, infection, or malignancy. It is also used to remove inoperable tumors and can be a life-saving procedure. Amputation can be either primary or secondary.
- Primary amputation: Performed without an attempt to restore blood flow and salvage the limb.
- Secondary amputation: Performed after a failed attempt at restoring blood flow and salvaging the limb
Reasons for amputation
There are numerous conditions that necessitate amputation. The procedure is often required when the tissue becomes damaged beyond repair, or to prevent the spread of infection.
- Peripheral artery disease: This is the most common cause of amputation. This disease restricts blood flow (ischemia) and causes poor circulation. When blood vessels narrow or become constricted, the tissue in the affected extremity can become necrotic and infection can set in.
- Nerve damage: Nerves are one of the four functional elements, along with vessels, bones, and soft tissue. Extensive nerve damage from an injury can render a limb dysfunctional and thus require amputation.
- Trauma: Trauma is the most frequent cause of amputation of the upper extremities, especially the fingers. Amputation is the only option when mangled limbs are unsalvageable and tissue becomes irreversibly damaged.
- Infection: Deep infections that do not respond to treatment and threaten to spread to the rest of the body often necessitate amputation. Necrotizing fasciitis is a particularly dangerous type of infection that spreads rapidly. This infection mainly affects the lower extremities but can also occur in the arms, hands, and fingers. Characterized by purple-colored skin and severe pain, necrotizing fasciitis causes tissue death and can be life-threatening. Amputation is usually required when the infection is accompanied by sepsis or diabetes.
Amputations are associated with a number of risks that depend on the patient’s age, the type of amputation, and any accompanying health issues.
- Hematoma: Hematoma of the stump is a possible complication of amputation. A hematoma is a type of bruise that occurs when blood collects outside of the blood vessels, resulting in purple or black discoloration of the skin.
- Infection: As with most surgical procedures, infection is a common complication of amputation. The stump is particularly vulnerable to infection after the amputation procedure. If the infection persists or spreads, further amputation may be necessary.
- Deep vein thrombosis: Deep vein thrombosis occurs when there is a blood clot in one of the deep veins in the body. It is most common with lower-extremity amputations, especially of the legs, due to immobility.
- Phantom limb pain: Phantom limb pain affects between 50 and 80 percent of upper-extremity-amputation patients. This refers to the perception of pain in the body part that has been amputated despite the fact that such a feeling is no longer possible. Phantom pain mainly affects men and occurs most frequently when there was a pain in the extremity before the procedure due to restricted blood flow.
Management and care
Like any other type of surgery, amputations require careful postoperative care to prevent infection and other complications and to promote successful rehabilitation. Wound care, early prosthesis fitting, and infection prevention are all important parts of postoperative care for amputations. Patients may also need pain management and support for stump pain and phantom limb pain.
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