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Amputation Health Article
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Author Info: Tish Davidson A.M., Monique Laberge Ph.D., The Gale Group Inc., Gale, Detroit, Gale Encyclopedia of Surgery, 2004 |
Definition
Amputation is the surgical removal of a limb or body part. It is performed to remove diseased tissue or relieve pain.
Purpose
Arms, legs, hands, feet, fingers, and toes can all be amputated. In the United States, there are approximately
Here in the United States, the most common causes of amputation of the lower extremity are: disease (70%), trauma (22%), congenital or birth defects (4%), and tumors (4%). As for upper extremity amputation, it is usually performed because of trauma or birth defect. Seldom is disease as great a contributing factor. The causes of amputation differ significantly in various countries. For example, countries with a recent history of warfare
Among the diseases and conditions that may lead to amputation of an extremity, the most prevalent are:
- hardening of the arteries
- arterial embolism
- impaired circulation as a complication of diabetes mellitus
- gangrene
- severe frostbite
- Raynaud's disease
- Buerger's disease
More than 90% of amputations performed in the United States are due to circulatory complications of diabetes. Sixty to eighty percent of these operations involve the legs.
Demographics
Most amputations involve small body parts such as a finger, rather than an entire limb. About 65,000 amputations are performed in the United States each year.
In the United States, there are approximately 350,000 amputees, with some 135,000 new amputations occurring each year. The number of amputees worldwide is not currently known.
Description
Amputations can be either planned or emergency procedures. Injury and arterial embolisms are the main reasons for emergency amputations. The operation is performed under regional or general anesthesia by a general or orthopedic surgeon in a hospital operating room.
Details of the operation vary slightly depending on what part is to be removed. All amputations consist of a two-fold surgical procedure: to remove diseased tissue so that the wound will heal 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, connective tissue, 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 about two weeks.
Diagnosis/Preparation
Before an amputation is performed, extensive testing is done to determine the proper level of amputation. 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.
The greater the blood flow through an area, the more likely healing is to occur. These tests are designed to measure blood flow through the limb. Several or all of them can be done to help choose the proper level of amputation.
- measurement of blood pressure in different parts of the limb
- xenon 133 studies, which use a radiopharmaceutical to measure blood flow
- oxygen tension measurements in which an oxygen electrode is used to measure oxygen pressure under the skin (If the pressure is 0, the healing will not occur. If the pressure reads higher than 40mm Hg [40 milliliters of mercury], healing of the area is likely to be satisfactory.)
- laser doppler measurements of the microcirculation of the skin
- skin fluorescent studies that also measure skin microcirculation
- skin perfusion measurements using a blood pressure cuff and photoelectric detector
- infrared measurements of skin temperature
No one test is highly predictive of healing, but taken together, the results give the surgeon an excellent idea of the best place to amputate.
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