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Amputation:- What is amputation? Amputation is surgery to remove all or part of a body appendage, usually a limb or extremity (an arm, leg, hand or foot). You might need surgery to amputate a body part if it’s too sick or injured to save and it endangers other parts. You might also need surgery if you lose a body part in a traumatic accident. When limb loss is unavoidable, amputation surgeons ensure that it’s clean and safe for the rest of you. Common types include: Arm amputation. Hand amputation. Finger amputation. Leg amputation. Foot amputation. Toe amputation. Less commonly, amputation can also mean removing a part of your face, like an ear, nose or tongue. A mastectomy is amputation of a breast. You can also have your testicles or penis removed (amputated). What are the different types of amputations? Doctors typically divide amputation types first into upper amputations and lower amputations. Upper amputations involve the fingers, wrist, or arm. Lower amputations involve the toes, ankle, or leg. Ideally, if you need an amputation, a doctor will speak with you about the need for a certain location and prosthetic options. The following are medical terms for certain amputation types. Upper extremity Transcarpal. An amputation of a finger or a portion of the hand. Wrist disarticulation. An amputation through the wrist. Transradial. An amputation below the elbow. Elbow disarticulation. Amputation through the elbow or at elbow level. Transhumeral. Amputation above the elbow. Shoulder disarticulation. Amputation at the shoulder. Lower extremity Toe amputation. Removal of one or more toes. Midfoot amputation. Removal of the toes and half of the foot, with the heel and ankle joint remaining. Also called a transmetatarsal amputation (TMA). Transtibial amputation. Also known as a below-knee amputation. Knee disarticulation. Also known as a through-knee amputation. Transfemoral amputation. An amputation above the knee. Hip disarticulation. An amputation in the area of the hip joint. Hemipelvectomy. An amputation of the entire leg and portion of the pelvis to the sacrum. Why is amputation sometimes necessary? According to 2020 researchTrusted Source, the largest percentage of amputations are related to chronic disease that impairs blood flow and affects bone tissue. However, there are additional amputation causes. Why is amputation done? Devastating injuries and diseases are the usual causes of surgical amputation. In many cases, the body part has lost its ability to function as it should. Nerves no longer return sensation from the part or allow you to move it at will. Or blood vessels no longer nourish the tissues. Loss of sensation can cause injuries that you don’t notice, leading to infections. Loss of blood flow will eventually cause the tissues to die. The surgery is usually a preventive measure. It helps preserve the health of the rest of your body. Tissue death, infections and cancer can easily spread from the sick part to the rest. A part that’s wounded beyond repair becomes a hazard if you can’t control it or protect it well enough. Removing the part also gives you the option to replace it with a more functional and aesthetic-looking prosthetic part. What are the most common causes of amputation? Common conditions that may lead to surgical amputation include: Complications of peripheral artery disease (PAD), which causes a loss of blood flow. Complications of diabetes, which causes nerve damage and loss of sensation. Nonhealing and/or infected foot and toe ulcers (often related to diabetes or PAD). Gangrene, tissue death from loss of blood flow, which can spread. Stage three frostbite that leads to irreversible tissue death. Life-threatening infections in your bones, joints or other tissues. Cancerous tumors that surgeons are unable to safely remove from your body part. Severe injuries, including severing, crushing and burn injuries. Procedure Details What happens before amputation surgery? If it’s not an emergency, you’ll go through a few steps of preparation before surgery: Assessment Your healthcare team will carefully assess the extent of your disease or injury. In some cases, they might be able to attempt to save your limb using advanced surgical techniques. This is called limb salvage surgery. If this is an option for you, your provider will discuss the risks and benefits with you. If not, they’ll use your assessment to plan your surgery. Counseling Amputation is more than the surgery itself. It’s a psychological and physical journey that will have lifelong repercussions. Likewise, your healthcare team will include more than surgeons. You may meet with a variety of therapists to prepare you for surgery and plan for your recovery. If you’re interested in a prosthetic limb, you’ll meet with a prosthetist to discuss your options. What happens during the procedure? During surgery, your surgeon will remove all diseased and damaged tissues. They’ll work to preserve as much healthy tissue as possible. They may need to repair individual nerves or blood vessels through microsurgery. They may also need to file or smooth the end of your bone, and they’ll often stitch your muscle to your bone to reinforce it. They’ll leave enough soft tissue at the end of the stump to close it. You may have discussed plans for a certain type of prosthesis with your surgeon. In some cases, they might perform extra steps in your surgery to prepare you for that prosthesis. Examples include: Target muscle reinnervation This option for upper limb amputees can make it easier to control a myoelectric arm or hand. After amputating, your surgeon redirects the severed nerves that controlled your amputated limb to a new “target muscle” somewhere else on your body — often in your shoulder or chest. This allows you to operate your prosthesis more intuitively by activating this other muscle. Osseointegration Osseointegration means integrating your prosthesis with your bone (osseo-). Your surgeon implants a metal anchor into your bone that extends from the end of your limb. Your prosthesis can attach directly to it. This makes the prosthesis easier to attach and remove. It also helps to prevent some of the skin complications that a traditional prosthesis socket can sometimes cause. Rotationplasty Rotationplasty is rare a procedure that involves amputating part or all of your upper leg and reattaching your healthy lower leg as your upper leg. Your surgeon rotates your lower leg so that your ankle bends the right way to replace your knee. This allows you to use a below-the-knee prosthesis with your shortened leg, instead of needing an above-the-knee prosthesis. What happens after surgery? You’ll spend a few days to weeks recovering in the hospital after surgery. You’ll have oxygen through a mask, fluids through an IV and pain control as needed. You may have a urinary catheter and bedpan, so you don’t have to get up to go to the bathroom. Your healthcare team will carefully monitor your wound healing. Within a few days, a physical therapist will begin guiding you in small daily exercises to prevent stiffness. You’ll continue your rehabilitation either at home or in a rehabilitation facility for people with limb loss. During this time, you’ll work with a variety of specialists to learn how to live with your changed body. Your rehabilitation will likely include: Physical therapy. You’ll need to move regularly to prevent your tissues from stiffening. You’ll also need to learn to use your body in new ways, relying on different muscles than you used to. Occupational therapy. An occupational therapist helps you learn to adapt your practical life to your new body. They’ll teach you new ways to accomplish routine tasks at home and at work. Psychotherapy. Amputation is a profound psychological event. It will take time to adjust and to process through the full range of feelings it can evoke. It’s a good idea to have a mental health professional to talk to during this time. Your mental health is important to your overall recovery. Prosthesis fitting and training. If you plan to use a prosthetic limb, you’ll begin the fitting process after you’ve recovered. You’ll then spend several months learning how to use it. Risks / Benefits What are the advantages of amputation? Surgical amputation is almost always a life-saving or life-preserving procedure. Occasionally, it’s a choice between removing a damaged and dysfunctional limb or salvaging it and living with it as-is. This might mean living with chronic pain, a constant safety hazard or a limb that you can’t use. Alternatively, removing and replacing it with a more functional prosthesis might improve your quality of life. What are the possible risks of amputation surgery? Any major surgery carries some risk of complications. These can occur during or after surgery. Those who need amputation surgery may be more at risk of complications than others. This is because they’re often already in poor health. Preexisting conditions like cardiovascular disease, trauma, cancer and infections can contribute to the risk of sudden respiratory failure, heart failure or kidney failure. Preexisting conditions can also make it difficult for your body to recover well. With reduced resources for healing, wounds may be slow to close or may reopen, and you may have excessive swelling or bleeding. Your stressed immune system may be too weak to fight infections like pneumonia, which can happen with extended bed rest. Bed rest and cardiovascular disease also make blood clots more likely. Amputations related to blood flow conditions Chronic disease and infection can lead to interrupted blood flow that jeopardizes a limb. When this is the case, a doctor may recommend amputation to preserve as much of the limb as possible. Chronic conditions are a leading cause of lower extremity amputations. The American Academy of Physical Medicine and Rehabilitation (AAPMR) estimates that 93.4 percent of all lower extremity amputations are related to vascular disease. This includes conditions such as diabetes and peripheral artery disease. The most common lower extremity amputations related to blood flow conditions are: toe (33.2 percent) transtibial (28.2 percent) transfemoral (26.1 percent) foot amputations (10.6 percent) Amputations due to chronic disease are associated with 5-year mortality ratesTrusted Source that are higher than some cancer types. This is because the need for amputation in many instances can indicate a person’s medical condition or overall health is worsening. Enhancing a person’s healthcare and overall health are excellent goals after amputation. Cancer-related amputations Cancer-related amputation accounts for 0.8 percent of total amputations. This is often due to bone cancer or cancer that has metastasized to the bone. However, cancer is the most common amputation cause for those between the ages of 10 and 20. Traumatic amputations Injuries and trauma can lead to amputations. An estimated 5.8 percent of lower limb amputations are related to trauma. This can include injuries from car accidents and workplace-related accidents. The Bureau of Labor Statistics estimates that 6,200 work-related amputations happened in the United States in 2018. More than 58 percent of these involved using some type of machinery, particularly metal and woodworking machinery. How amputations affect the body Because amputation removes a portion of the body that was naturally present, it’s easy to wonder how this affects your overall health. There are undeniably effects that can occur due to amputation. It’s important to work with your doctor and physical therapist to minimize these effects whenever possible. Examples include: changes in your center of gravity and balance increased risk of arthritis in your remaining limb (if applicable) because it often has to increase its workload back pain due to changes in the body’s positioning for lower limb amputees Often, the effects of an amputation are related to where it is and your overall health. Amputation complications Amputations are surgical procedures that have risks involved. Also, if the amputation was the result of trauma or infection, you may have other medical conditions to recover from as well. This can complicate recovery after amputation. According to the AAPMR, some of the most common amputation complications include: infection pinched nerve phantom limb sensation and pain (feeling as if the limb is still there, even if it isn’t) residual limb pain Another complication is joint contracture. This is when the remaining muscles, tendons, and other tissues tighten so much that you can’t move the remaining joint. How long does it take to recover from surgery? Recovery times can vary. In general, it takes two to three months for your surgical wounds to heal and your swelling to go down. Once your residual limb has settled into its final size and shape, you can begin fitting for a prosthesis. You’ll begin physical therapy as soon as possible after surgery. You’ll likely continue with it for at least six months. Training to use a prosthetic limb can take even longer. Amputation healing time and recovery tips Amputation healing times can vary by the event that caused the amputation and the amputation site. For example, amputations due to chronic conditions such as diabetes or peripheral artery disease may take longer to heal. Blood flow and wound healing are already impaired by these conditions, which may extend recovery times. A small 2018 study suggests it likely takes less time to recover from a toe amputation than a leg amputation. A surgeon should help you determine your expected recovery period. Some tips to help the recovery process: Follow wound care instructions carefully. Most surgical incision sites should be kept clean and dry. Notify your doctor if you experience significant drainage or infection signs. Take medications such as antibiotics as prescribed. This can help prevent surgical site infections. Participate in physical therapy as you are able to keep muscles strong and tendons and other tissues mobile. It can take time to regain function after an amputation. Some individuals undergoing leg amputations reported it took as many as 6 months to regain their functional independence. How painful is amputation? If you experience it consciously, limb amputation is one of the most painful assaults your body can endure. Fortunately, you won’t feel it during surgery, and you’ll have strong pain control after surgery. While you’ll probably experience some postoperative pain, your healthcare team will do their best to help you manage it. However, limb loss can lead to other, longer-lasting pain syndromes, including: Residual limb pain. Pain in your residual limb or “stump” can have a variety of causes. Nerve damage from surgery can cause recurring nerve pain. Using a prosthesis can irritate the skin on your stump in various ways. You should address these issues with your prosthetist. Phantom limb pain. Many amputees experience periodic sensations, such as pain, that seem to come from their amputated limb. This happens because the severed nerves continue to transmit signals to your brain. Address phantom limb pain with your provider. Psychological pain. Understandably, limb loss can cause significant psychological distress, especially when it’s unexpected. It can feel overwhelming and can raise your risk of clinical depression and PTSD. You’ll need professional support to process the psychological pain. Where do amputated limbs go? If you are wondering where amputated limbs go, you aren’t alone. Especially if you’re about to undergo an amputation, it’s fairly common to ask questions about how and where these limbs are disposed of. A 2019 study described four potential destinationsTrusted Source for your limb after the procedure. The limb could be: sent to a biohazard crematoria where it is destroyed donated to a medical college for use in dissection sent to a pathologist for testing, such as for cancer cells or infection returned to you if you have a proven religious need to retain the limb

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