What Is An Amputation?
An amputation is the removal of a diseased or injured body part, like an arm, leg, hand, toe, or finger. An amputation can be the result of a traumatic accident (such as a car accident) or a well-planned operation designed to prevent the spread of a particular type of disease into other body parts. Sometimes, amputated limbs may be reattached or replanted, however, most of the time, reattachment is not possible.
Approximately 1.8 million people in the US live with amputations. The most common cause for an amputation is Peripheral Artery Disease, which accounts for 90% of all amputation cases. The most common amputation procedure is a below or above the knee amputation of the leg.
Amputations are almost always performed as a last resort.
Why Are Amputations Performed?
There are a number of reasons why an amputation may be deemed necessary. An amputation is generally the final treatment performed when all other options have failed. Most people who have an amputation performed have peripheral artery disease, cancer, or a traumatic injury.
The most common reason that an amputation is performed is due to impaired or poor circulation to the peripheral body parts (arms, hands, feet, toes) due to peripheral artery disease, or PAD. PAD accounts for 90% of all amputations.
For people who have peripheral artery disease, the blood vessels of the limbs are damaged by hardening of the arteries due to plaques or as a complication of diabetes: diabetic neuropathy. Diabetic neuropathy occurs when the nerves in the body are damaged by uncontrolled blood sugars.
Without proper blood circulation, the cells of these body parts do not receive enough oxygen and nutrients to survive. As the tissue receives less and less oxygen, the tissue begins to die. When these tissues die, nasty infections like gangrene can set in.
Advanced PAD is first treated by controlling infection with antibiotics, removal of infected tissues, draining the wound, and other procedures that can increase blood flow to the affected limb. If these standard treatments do not work, if the tissue damage is too extensive, an amputation reduces the risks for systemic infections.
Amputations may also be performed after such things as traumatic injury from an accident (such as a car or a severe burn) that destroys blood vessels and leads to tissue and cell death in an extremity. Every effort will be made to surgically repair damaged blood vessels by performing surgical operations or using donor tissue. An amputation may be performed if these methods do not work or if a life-threatening infection begins to set in. In people younger than fifty, traumatic injuries are the most common cause for amputations.
If a cancerous tumor develops in the bone or muscle of a limb, amputation, plus chemotherapy and/or radiation may be the treatment of choice.
How Does One Prepare For An Amputation?
As amputation is a treatment of last resort, the following will be assessed to ascertain whether or not the limb can be saved or amputated, and the likelihood of post-surgical complications. Physical assessment may include:
- Presence of a fever
- The temperature of the skin surrounding the wound
- Whether or not the skin is painful to the touch
- Smell or putrid odor coming from the wound
- Color of the skin surrounding the wound
- Infected sores or non-healing wounds
The assessment will also ascertain how well (if any) the blood is reaching the limbs. The tests performed may include:
- Blood pressure testing
- CT Scan
- MRI Scan
- Duplex Ultrasound
Other health-related issues that may be taken into consideration while considering an amputation may include:
- Diagnosis of Diabetes (type I or II)
- Heart or other circulatory system abnormalities
- Poor kidney function
Other things that are likely to be discussed prior to amputation include:
- Measurement for artificial limb
- Pre-surgical counseling to help cope with the loss of a limb
- Coordination with rehabilitation team
- Any home care needs that can be arranged before surgery, including any railings, toileting devices, and other pieces of durable medical equipment that may need to be ordered
How Is An Amputation Performed?
When an amputation is deemed necessary, a skilled surgeon will remove the injured or diseased body part. The amputation procedure involves a hospital stay of at least five days (often longer), depending upon the surgery, post-surgical complications, and the extremity being removed.
The procedure the surgeon uses will vary depending upon the limb being amputated as well as the overall health of the person undergoing the amputation procedure.
Amputations are often performed under general anesthesia; occasionally using spinal anesthesia only (which numbs the body from the waist down). During the surgical procedure, the surgeon removes as much of the damaged tissue as he or she can while leaving as much healthy tissue intact.
What Happens During An Amputation Procedure?
We've all heard stories, or seen in the movies, of people who went in for an amputation of one limb and had the other removed. This is why in the preoperative area, the nurse will often have the person sign or initial the limb to ensure that the proper limb is removed.
During the amputation procedure itself, the surgeon will perform the following. First, he or she will remove all diseased tissue and/or crushed bone from the site of the amputation, while preserving as much of the healthy skin, nerves, and blood vessels as possible.
Choosing the proper incision site is an important aspect of an amputation procedure - if the surgeon removes too little of the diseased tissues, the wound will not properly heal, especially if blood circulation is not restored to the area.
The surgeon will examine the tissue to be amputated. Things that the surgeon will examine include the following:
- The strength of the pulse closest to the point of surgical entry to ascertain the proper amount of blood circulation to the area of the wound.
- He or she will examine the area to be amputated for patches of reddened, streaky skin, as an incision made in an area of reddened skin will be less apt to heal properly.
- Checking the sensitivity of the skin near where the surgeon plans to cut.
- Comparing temperatures of the infected/diseased limb to the other limb.
During the operation, the surgeon may decide that more of the limb will be removed, if the edges of the skin surrounding the amputation do not properly bleed (implying proper circulation, therefore proper wound healing).
An anesthetist will use general sedation or numb the region of the body that will be amputated with a regional spinal block or other type of nerve block. Heart rate and other vital signs will be monitored throughout the surgery.
The surgeon will:
- Smooth out any uneven areas of bone (as may be the case after a traumatic accident involving the bone).
- Cauterize the blood vessels and nerves.
- Shape the muscles so that the stump at the end of the limb will be able to have an artificial limb or prosthesis attached in post-operative care.
Depending upon the type of amputation performed, the surgeon may opt for one of two types of closures:
1) Closed Amputation: in a closed amputation, a surgeon closes the wound in the operating room, sewing the flaps of skin together immediately. A closed amputation is performed if the surgeon feels confident that there is a decreased chance for infection and a greater likelihood for proper healing.
2) Open Flap Amputation - the wound site is left open after surgery for several days post-op so that the surgeon can spend the next several days cleaning any questionable or infected tissue. Once all the stump tissue is clean and free of infections, the skin flaps are sewn together to close the wound. This procedure is called "delayed closure."
The surgical team will then place a stocking over the stump that can hold dressings and drainage tubes, while the limb is placed in traction or in a splint.
Are There Complications Following An Amputation?
Other health-related issues, such as diabetes and heart disease can increase the risk for post-surgical complications. An amputation following a traumatic injury also increases the risks for post-op complications. Those who have an above-the-knee amputation are also at greater risks for complications than those done below the knee.
Post-Op amputation complications can include:
- Contracture - a joint deformity
- Hematoma - a severe type of bruise
- Necrosis - death of the skin and/or muscle flaps surrounding the amputation
- Wound reopening - due to poor healing
These complications will be treated as they arise. Rarely do people require a second amputation or additional surgical treatments.
What Happens After An Amputation?
After an amputation, a hospital stay of five or more days is generally required, although the length of stay will vary by condition. During this stay, the person who has had the amputation will learn how to change the dressings, keep an eye on the wound for any infection and ensure proper wound healing is occurring. A wound generally takes 4-8 weeks to heal post-op.
As healing permits, physical therapy will begin. This type of therapy includes stretching and exercising as permitted by the condition.
Some people who experience amputation may begin to practice using an artificial limb as soon as 10-14 days after the amputation.
What Is Phantom Limb Pain?
Phantom Limb Pain is mild to intense pain felt in the area where a limb has been removed via amputation. Phantom Limb Pain may also include sensations of cramping, heat, or cold within the limb that is no longer there. Generally, the sensations associated with Phantom Limb Pain will disappear within six months.
Phantom Limb Pain is caused by nerve ending at the site of the amputation that sends pain signals to the brain. Sometimes, the memory of the pain is retained and is interpreted as pain regardless of signals from the injured nerves.
What Are Prosthetic Devises?
When a limb is amputated, a prosthetic device (prosthesis) may aid in rehabilitation. For many who have undergone an amputation, using a prosthesis can mean the difference between achieving independence and mobility, and remaining bed-bound.
There exist many types of prostheses available for those who have undergone an amputation. These include:
- Lower Leg and Foot - there are many types of prosthetic feet that can simulate the actions a natural foot can perform.
- Leg and Knee - for above-the-knee amputations, there exist prosthetics available that can simulate both the leg and ankle joint.
- Arm and Hand - the most commonly used prosthetic arm and hand relies upon the body's own movements and a harness that crosses the back.
A prosthesis is designed and fitted by a medical professional called a "prosthetist" generally in the hospital shortly after the limb has been amputated.
Tips For Keeping Comfortable While Using A Prosthetic Limb:
To allow for the greatest benefits of a new prosthetic while minimizing potential problems, it's important to follow some basic instructions and guidelines:
- Remove the prosthetic limb before going to bed at night.
- Make sure the prosthesis is regularly cleaned.
- Wear dry socks if you're using a leg prosthesis.
- Before going to bed, examine the prosthesis for any damage or parts that have become loose.
- Examine your healing stump for signs of irritation, such as redness or blisters. Make examining your stump one of the things you do each day - check for sores or wounds that can indicate infections. If you cannot see the stump, use a mirror or have someone else help you to examine the area.
- Ensure that the stump is properly moisturized and cleaned.
- Perform all exercises in the way that your physical therapist recommends.
- While not wearing your prosthetic device, be sure to place a bandage upon the stump, which can help to decrease swelling in the area.
- If using a leg prosthetic, make sure that the shoe placed on the prosthesis is the proper height to match the other leg's shoe height.
- Maintain your body wait to ensure that the prosthesis fits properly - fluctuations in weight can change the way the prosthetic device works.
- Make sure to get regularly scheduled maintenance on your prosthetic to ensure that it fits properly and all is working as it should.
Things To Keep In Mind Post-Amputation:
It's important for all amputees to remember that losing a limb is still a loss - and it may be a hard loss emotionally to grieve. Do allow yourself the time to properly mourn your lost limb - even if it seems silly. A loss is a loss is a loss.
Adjusting to new body image may take some time and energy, and that's okay.
If you're having trouble emotionally coping with the loss of a limb, do not hesitate to reach out to a therapist who specializes in these problems.
In time, with occupational therapy, you will learn to use your new limb and other types of assistance devices designed to help you adjust to using a prosthesis.
Additional Amputation Resources:
National Amputation Foundation: The Foundation sponsors an Amp-to Amp program. Whenever feasible, an amputee member of our organization who has returned to a normal life, visits the new amputee.
Limbless Association: provides information and support to the limb-loss community. We aim to support people of all ages and backgrounds through a variety of existing programs and services.
American Amputee Foundation Inc: a national information clearinghouse and referral center serving amputees, their families, and care providers. The foundation researches and gathers information on amputation including studies, product information, available services, self-help publications, and hundreds of articles concerning amputation and related conditions.
Amputee Coalition: Mission is to reach out to and empower people affected by limb loss to achieve their full potential through education, support and advocacy, and to promote limb loss prevention.
Survivors Guide For The Recent Amputee - provides the new amputee with pertinent information regarding amputation, care of the residual limb, prosthetics, returning to daily activities and a variety of other topics.