Amputation

Amputation is the intentional surgical removal of a limb or body part. It isperformed to remove diseased tissue or to relieve pain. Amputation is performed to remove tissue that no longer has an adequate blood supply; to remove malignant tumors; and because of severe trauma to the body part. About 65,000 amputations are performed in the United States each year. More than 90% of theamputations are due to circulatory complications of diabetes, and most of these operations involve the legs.

Amputations can be either planned or emergency procedures. Injury and arterial embolisms are the main reasons for emergency amputations. Amputations cannot be performed on patients with uncontrolled diabetes mellitus, heart failure, or infection. Patients with blood clotting disorders are also not good candidates for amputation.

The operation is performed under regional or general anesthesia by a generalor orthopedic surgeon in a hospital operating room. Details of the operationvary slightly depending on what part is to be removed. The goal of all amputations is twofold: to remove diseased or damaged tissue so that the wound willheal 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, connectivetissue, 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 abouttwo weeks.

Before an amputation is performed, extensive testing is done to determine theproper level of amputation. Other tests measure the blood flow through the area. The greater the blood flow, the more likely healing is to occur. 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.

After amputation, medication is prescribed for pain, and patients are treatedwith antibiotics to prevent infection. The stump is moved often to encouragegood circulation. Physical therapy and rehabilitation are started as soon aspossible, usually within 48 hours. There is a positive relationship betweenearly 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 can be a long, difficult process. Twice daily physical therapyis not uncommon. Additionally, psychological counseling is an important partof rehabilitation. Many people feel a sense of loss and grief when they losea 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 missing limb. Many amputees benefit from joining self-help groups and meeting other amputees.

Amputation is major surgery. All the risks associated with anesthesia exist,along with the possibility of heavy blood loss and the development of blood clots. Infection is a special concern. Infection rates in amputations average15%. If the stump becomes infected, it is necessary to remove the prosthesisand 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. Centers that specialize in amputation usually have thelowest rates of complication.

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