Amputation
Encyclopedia
Amputation is the removal of a body extremity by trauma
, prolonged constriction, or surgery
. As a surgical measure, it is used to control pain or a disease process in the affected limb, such as malignancy
or gangrene
. In some cases, it is carried out on individuals as a preventative surgery for such problems. A special case is the congenital amputation
, a congenital disorder
, where fetal
limbs have been cut off by constrictive bands. In some countries, amputation of the hands or feet is or was used as a form of punishment
for people who committed crimes. Amputation has also been used as a tactic in war and acts of terrorism; it may also occur as a war injury. In some cultures and religions, minor amputations or mutilations are considered a ritual accomplishment. Unlike some non-mammalian animals (such as lizard
s that shed their tails, salamanders that can regrow many missing body parts, and hydras, flatworms, and starfish that can regrow entire bodies from small fragments), once removed, human extremities do not grow back, unlike portions of some organs, such as the liver
. A transplant
or a prosthesis
are the only options for recovering the loss.
In the US, the majority of new amputations occur due to complications of the vascular system (of or pertaining to the blood vessels), especially from diabetes. Between 1988 and 1996, there was an average of 133,735 hospital discharges for amputation per year in the US. .
Hemicorporectomy
, or amputation at the waist, and decapitation
, or amputation at the neck, are the most radical amputations.
Genital modification and mutilation
may involve amputating tissue, although not necessarily as a result of injury or disease.
As a rule, partial amputations are preferred to preserve joint function, but in oncological surgery, disarticulation is favored.
Even rarer are cases where self-amputation is performed for criminal or political purposes:
Body Integrity Identity Disorder
is a psychological condition in which an individual feels compelled to remove one or more of their body parts, usually a limb. In some cases, that individual may take drastic measures to remove the offending appendages, either by causing irreparable damage to the limb so that medical intervention cannot save the limb, or by causing the limb to be severed.
The first step is ligating
the supplying artery
and vein
, to prevent hemorrhage (bleeding). The muscles are transected, and finally the bone
is sawed through with an oscillating saw. Sharp and rough edges of the bone(s) are filed down, skin and muscle flaps are then transposed over the stump, occasionally with the insertion of elements to attach a prosthesis
.
Methods in preventing amputation depend on the problems that might cause amputations to be necessary. Chronic infections, often caused by diabetes or decubitus ulcers in bedridden patients, are common causes of infections that lead to gangrene, which would then necessitate amputation.
There are two key challenges: first, many patients have impaired circulation in their extremities, and second, they have difficulty curing infections in limbs with poor vasculation (blood circulation).
Various approaches have been attempted to work around these problems, including hyperbaric oxygen therapy
(HBOT) and low powered lasers. HBOT has proved to be particularly effective in revascularizing or rebuilding the smaller blood vessels in extremities and, as a result, preventing deterioration of the tissue and resulting infections. At the same time, delivering oxygen under pressure in a hyperbaric chamber increases oxygenation by up to 400 times in the blood, speeding up healing processes and killing off anaerobic bacteria (gas gangrene), the source of infections. The general research conclusion is that around 80% of resistant diabetic infections can be cured with HBOT.
Crush injuries where there is extensive tissue damage and poor circulation also benefit from HBOT. The high level of oxygenation and revascularization speed up recovery times and prevent infections.
A study found that the patented method called Circulator Boot got significant results in prevention of amputation in patients of diabetes and arterioscleorosis. Another study found it also effective for healing limb ulcers caused by peripheral vascular disease. The boot checks the heart rhythm and compresses the limb between heartbeats; the compression helps cure the wounds in the walls of veins and arteries, and helps to push the blood back to the heart.
For victims of trauma, advances in microsurgery
in the 1970's have made replantations of severed body parts possible.
A large proportion of amputees (50-80%) experience the phenomenon of phantom limb
s; they feel body parts that are no longer there. These limbs can itch, ache, burn, feel tense, dry or wet, locked in or trapped or they can feel as if they are moving. Some scientists believe it has to do with a kind of neural map that the brain has of the body, which sends information to the rest of the brain about limbs regardless of their existence. Phantom sensations and phantom pain may also occur after the removal of body parts other than the limbs, e.g. after amputation of the breast, extraction of a tooth (phantom tooth pain) or removal of an eye (phantom eye syndrome
).
A similar phenomenon is unexplained sensation in a body part unrelated to the amputated limb. It has been hypothesized that the portion of the brain responsible for processing stimulation from amputated limbs, being deprived of input, expands into the surrounding brain, (Phantoms in the Brain: V. S. Ramachandran and Sandra Blakeslee) such that an individual who has had an arm amputated will experience unexplained pressure or movement on his face or head.
In many cases, the phantom limb aids in adaptation to a prosthesis, as it permits the person to experience proprioception
of the prosthetic limb. To support improved resistance or usability, comfort or healing, some type of stump sock
s may be worn instead of or as part of wearing a prosthesis.
Another side effect can be heterotopic ossification
, especially when a bone injury is combined with a head injury. The brain signals the bone to grow instead of scar tissue to form, and nodules and other growth can interfere with prosthetics and sometimes require further operations. This type of injury has been especially common among soldiers wounded by improvised explosive device
s in the Iraq war.
Due to technologic advances in prosthetics, amputees can live active lives with little restriction. Organizations such as the Challenged Athletes Foundation
have been developed to give amputees the opportunity to be involved in athletics and adaptive sports such as Amputee Soccer
.
amputare, "to cut away", from ambi- ("about", "around") and putare ("to prune"). The Latin word has never been recorded in a surgical context, being reserved to indicate punishment for criminals. The English word "amputation" was first applied to surgery in the 17th century, possibly first in Peter Lowe's A discourse of the Whole Art of Chirurgerie (published in either 1597 or 1612); his work was derived from 16th century French texts and early English writers also used the words "extirpation" (16th century French texts tended to use extirper), "disarticulation
", and "dismemberment
" (from the Old French desmembrer and a more common term before the 17th century for limb loss or removal), or simply "cutting", but by the end of the 17th century "amputation" had come to dominate as the accepted medical term.
Physical trauma
Trauma refers to "a body wound or shock produced by sudden physical injury, as from violence or accident." It can also be described as "a physical wound or injury, such as a fracture or blow." Major trauma can result in secondary complications such as circulatory shock, respiratory failure and death...
, prolonged constriction, or surgery
Surgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
. As a surgical measure, it is used to control pain or a disease process in the affected limb, such as malignancy
Cancer
Cancer , known medically as a malignant neoplasm, is a large group of different diseases, all involving unregulated cell growth. In cancer, cells divide and grow uncontrollably, forming malignant tumors, and invade nearby parts of the body. The cancer may also spread to more distant parts of the...
or gangrene
Gangrene
Gangrene is a serious and potentially life-threatening condition that arises when a considerable mass of body tissue dies . This may occur after an injury or infection, or in people suffering from any chronic health problem affecting blood circulation. The primary cause of gangrene is reduced blood...
. In some cases, it is carried out on individuals as a preventative surgery for such problems. A special case is the congenital amputation
Congenital amputation
Congenital amputation is a congenital disorder that can be caused by fibrous bands of the amnion that constrict foetal limbs to such an extent that they fall off due to missing blood supply. The child is born without one or more limbs or without parts of limbs .-Causes:Congenital amputations can...
, a congenital disorder
Congenital disorder
A congenital disorder, or congenital disease, is a condition existing at birth and often before birth, or that develops during the first month of life , regardless of causation...
, where fetal
Fetus
A fetus is a developing mammal or other viviparous vertebrate after the embryonic stage and before birth.In humans, the fetal stage of prenatal development starts at the beginning of the 11th week in gestational age, which is the 9th week after fertilization.-Etymology and spelling variations:The...
limbs have been cut off by constrictive bands. In some countries, amputation of the hands or feet is or was used as a form of punishment
Punishment
Punishment is the authoritative imposition of something negative or unpleasant on a person or animal in response to behavior deemed wrong by an individual or group....
for people who committed crimes. Amputation has also been used as a tactic in war and acts of terrorism; it may also occur as a war injury. In some cultures and religions, minor amputations or mutilations are considered a ritual accomplishment. Unlike some non-mammalian animals (such as lizard
Lizard
Lizards are a widespread group of squamate reptiles, with nearly 3800 species, ranging across all continents except Antarctica as well as most oceanic island chains...
s that shed their tails, salamanders that can regrow many missing body parts, and hydras, flatworms, and starfish that can regrow entire bodies from small fragments), once removed, human extremities do not grow back, unlike portions of some organs, such as the liver
Liver
The liver is a vital organ present in vertebrates and some other animals. It has a wide range of functions, including detoxification, protein synthesis, and production of biochemicals necessary for digestion...
. A transplant
Organ transplant
Organ transplantation is the moving of an organ from one body to another or from a donor site on the patient's own body, for the purpose of replacing the recipient's damaged or absent organ. The emerging field of regenerative medicine is allowing scientists and engineers to create organs to be...
or a prosthesis
Prosthesis
In medicine, a prosthesis, prosthetic, or prosthetic limb is an artificial device extension that replaces a missing body part. It is part of the field of biomechatronics, the science of using mechanical devices with human muscle, skeleton, and nervous systems to assist or enhance motor control...
are the only options for recovering the loss.
In the US, the majority of new amputations occur due to complications of the vascular system (of or pertaining to the blood vessels), especially from diabetes. Between 1988 and 1996, there was an average of 133,735 hospital discharges for amputation per year in the US. .
Types
Types of amputation include:- LegLegŁęg may refer to the following places in Poland:*A former name for the town of Ełk *Part of the Czyżyny district of Kraków*Łęg, Pleszew County in Greater Poland Voivodeship...
- amputation of digitsToeToes are the digits of the foot of a tetrapod. Animal species such as cats that walk on their toes are described as being digitigrade. Humans, and other animals that walk on the soles of their feet, are described as being plantigrade; unguligrade animals are those that walk on hooves at the tips of...
- partial foot amputation (Chopart, LisfrancTarsometatarsal articulationsThe tarsometatarsal articulations are arthrodial joints in the foot.It is also known as the "Lisfranc joint". It is named after 18th-19th century surgeon and gynecologist, Jacques Lisfranc de St...
, Ray) - ankle disarticulation (Syme, Pyrogoff)
- below-knee amputation (transtibial e.g. Burgess, Kingsley Robinson)
- knee-bearing amputation (knee disarticulation, e.g. Gritti or Gritti-Stokes)
- above knee amputation (transfemoral)
- Van-ness rotation/rotationplastyRotationplastyRotationplasty is type of autograft wherein a portion of a limb is removed, while the remaining limb below the involved portion is rotated and reattached. This procedure is used when a portion of an extremity is injured or involved with a disease, such as cancer.Typically the ankle joint becomes...
(Foot being turned around and reattached to allow the ankle joint to be used as a knee.) - hip disarticulation
- hemipelvectomyHemipelvectomyA hemipelvectomy is a high level pelvic amputation. Along with hip disarticulations, hemipelvectomies are the rarest of lower extremity amputations. In some cases, an internal hemipelvectomy can be performed, which is a limb-sparing procedure. A complete hemipelvectomy, however, is the...
/hindquarter amputation
- amputation of digits
- ArmArmIn human anatomy, the arm is the part of the upper limb between the shoulder and the elbow joints. In other animals, the term arm can also be used for analogous structures, such as one of the paired forelimbs of a four-legged animal or the arms of cephalopods...
- amputation of digitsFingerA finger is a limb of the human body and a type of digit, an organ of manipulation and sensation found in the hands of humans and other primates....
- metacarpal amputation
- wrist disarticulation
- forearm amputation (transradial)
- elbow disarticulation
- above-elbow amputation (transhumeral)
- shoulder disarticulation and forequarter amputationForequarter amputationForequarter amputation is amputation of the arm, scapula & clavicle. It is usually performed as a last resort to remove a cancer, but decreasingly so as limb-sparing operations improve.- Surgical technique :...
- Krukenberg procedureKrukenberg procedureThe Krukenberg procedure also known as the Krukenberg operation is a surgical technique that converts a forearm stump into a pincer. It was first described in 1917 by the German army surgeon Hermann Krukenberg...
- amputation of digits
- Teeth
- The avulsion of some teeth (mainly incisives) is or was practiced by some cultures for ritual purposes (for instance in the IberomaurusianIberomaurusianThe Iberomaurusian culture is a backed bladelet industry found throughout the Maghreb. The industry was originally described in 1909 by the French scholar Pallary, at the site of Abri Mouillah...
culture of Neolithic North AfricaPrehistoric Central North Africa- Early and middle Paleolithic :Earlier inhabitants of central North Africa have left behind equally significant remains. Early remnants of hominid occupation in North Africa, for example, were found in Ain el Hanech, near Saïda ; in fact, more recent investigations have found signs of Oldowan...
).
- The avulsion of some teeth (mainly incisives) is or was practiced by some cultures for ritual purposes (for instance in the Iberomaurusian
- Facials
- amputation of the ears.
- amputation of the nose.
- amputation of the tongue.
- amputation of eyes blindingBlindingBlinding can refer to:*The act of making someone blind**Metaphorical and extended uses of same: see blindness#Metaphorical uses*Blinding , a technique by which an agent can provide a service to a client in an encoded form without knowing either the real input or the real output*Blinding , a novel...
. Many of these facial disfigurings were and still are done in some parts of the world as punishment to some crimes, and as individual shame and population terror practices.
- Breasts
- amputation of female mammaries. MastectomyMastectomyMastectomy is the medical term for the surgical removal of one or both breasts, partially or completely. Mastectomy is usually done to treat breast cancer; in some cases, women and some men believed to be at high risk of breast cancer have the operation prophylactically, that is, to prevent cancer...
This was done still during the Middle AgesMiddle AgesThe Middle Ages is a periodization of European history from the 5th century to the 15th century. The Middle Ages follows the fall of the Western Roman Empire in 476 and precedes the Early Modern Era. It is the middle period of a three-period division of Western history: Classic, Medieval and Modern...
after enemy razzias as mass abuse and extreme individual punishment to prevent women from suckling their children and doom them, still able to bear but unabling them to nurse and thus, to see with despair their neonates die.
- amputation of female mammaries. Mastectomy
- Genitals
- amputation of the scrotum.
- amputation of the testicles (castrationCastrationCastration is any action, surgical, chemical, or otherwise, by which a male loses the functions of the testicles or a female loses the functions of the ovaries.-Humans:...
). - amputation of the penis (penectomyPenectomyPenectomy is the surgical removal of the penis for medical or personal reasons.- Medical Reasons for Penectomy :Cancer, for example, sometimes necessitates removal of part or of the penis. The amount of the penis removed depends on the severity of the cancer. Some men have only the tip of their...
) - amputation of the foreskinForeskinIn male human anatomy, the foreskin is a generally retractable double-layered fold of skin and mucous membrane that covers the glans penis and protects the urinary meatus when the penis is not erect...
(circumcisionCircumcisionMale circumcision is the surgical removal of some or all of the foreskin from the penis. The word "circumcision" comes from Latin and ....
) - amputation of the clitoris (clitoridectomyClitoridectomyClitoridectomy is the surgical removal of the clitoris. It is rarely needed as a therapeutic medical procedure, such as when cancer has developed in or spread to the clitoris...
)
Hemicorporectomy
Hemicorporectomy
In medicine , hemicorporectomy is a radical surgery in which the body below the waist is amputated, transecting the lumbar spine. This removes the legs, the genitalia , urinary system, pelvic bones, anus, and rectum...
, or amputation at the waist, and decapitation
Decapitation
Decapitation is the separation of the head from the body. Beheading typically refers to the act of intentional decapitation, e.g., as a means of murder or execution; it may be accomplished, for example, with an axe, sword, knife, wire, or by other more sophisticated means such as a guillotine...
, or amputation at the neck, are the most radical amputations.
Genital modification and mutilation
Genital modification and mutilation
The terms genital modification and genital mutilation can refer to permanent or temporary changes to human sex organs. Some forms of genital alteration are performed at the behest of an adult, with their informed consent. Others are performed on infants or children...
may involve amputating tissue, although not necessarily as a result of injury or disease.
As a rule, partial amputations are preferred to preserve joint function, but in oncological surgery, disarticulation is favored.
Self-amputation
In some rare cases when a person has become trapped in a deserted place, with no means of communication or hope of rescue, the victim has amputated their own limb:- In 2007, 66-year-old Al Hill amputated his leg below the knee using his pocketknife after the leg got stuck beneath a fallen tree he was cutting in CaliforniaCaliforniaCalifornia is a state located on the West Coast of the United States. It is by far the most populous U.S. state, and the third-largest by land area...
. - In 2007, Sampson Parker, a South Carolina farmer cut off his own arm after it got stuck in a corn harvester.
- In 2003, 27-year-old Aron RalstonAron RalstonAron Lee Ralston is an American mountain climber and inspirational public speaker. He is widely known for having survived a 2003 canyoneering accident in Utah in which he was forced to amputate his own right arm with a dull pocketknife in order to free himself from a dislodged boulder.The incident...
amputated his forearmForearm-See also:*Forearm flexors*Forearm muscles...
using his pocketknife and breaking and tearing the two boneBoneBones are rigid organs that constitute part of the endoskeleton of vertebrates. They support, and protect the various organs of the body, produce red and white blood cells and store minerals. Bone tissue is a type of dense connective tissue...
s, after the arm got stuck under a boulder when hiking in UtahUtahUtah is a state in the Western United States. It was the 45th state to join the Union, on January 4, 1896. Approximately 80% of Utah's 2,763,885 people live along the Wasatch Front, centering on Salt Lake City. This leaves vast expanses of the state nearly uninhabited, making the population the...
. - In 2003, an Australian coal miner amputated his own arm with a Stanley knife after it became trapped when the front-end loader he was driving overturned three kilometers underground.
- In the 1990s, a crab fisherman got his arm caught in the winch during a storm and had to amputate it at the shoulder, as reported in The New Englander.
Even rarer are cases where self-amputation is performed for criminal or political purposes:
- About 50 people in Vernon, FloridaVernon, FloridaVernon is a city in Washington County, Florida, United States. The population was 743 at the 2000 census; according to the U.S. Census Bureau's 2004 estimates, the city had a population of 757....
collected insurance claims for loss-of-limb accidents in the late 1950s and early 1960s; this was more than two-thirds of all such claims in the United States during that time. - On March 7, 1998, Daniel Rudolph, the elder brother of the 1996 Olympics bomberCentennial Olympic Park bombingThe Centennial Olympic Park bombing was a terrorist bombing on July 27, 1996 in Atlanta, Georgia, United States during the 1996 Summer Olympics, the first of four committed by Eric Robert Rudolph...
Eric Robert RudolphEric Robert RudolphEric Robert Rudolph , also known as the Olympic Park Bomber, is a criminal responsible for a series of bombings across the southern United States between 1996 and 1998, which killed two people and injured at least 150 others in the name of an anti-abortion and anti-gay agenda...
, videotaped himself cutting off one of his own hands with an electric saw in order to "send a message to the FBI and the media."
Body Integrity Identity Disorder
Body integrity identity disorder
Body Integrity Identity Disorder , formerly known as Amputee Identity Disorder, is a psychological disorder wherein sufferers feel they would be happier living as an amputee...
is a psychological condition in which an individual feels compelled to remove one or more of their body parts, usually a limb. In some cases, that individual may take drastic measures to remove the offending appendages, either by causing irreparable damage to the limb so that medical intervention cannot save the limb, or by causing the limb to be severed.
Circulatory disorders
- Diabetic foot infection or gangreneGangreneGangrene is a serious and potentially life-threatening condition that arises when a considerable mass of body tissue dies . This may occur after an injury or infection, or in people suffering from any chronic health problem affecting blood circulation. The primary cause of gangrene is reduced blood...
(the most common reason for non-traumatic amputation) - SepsisSepsisSepsis is a potentially deadly medical condition that is characterized by a whole-body inflammatory state and the presence of a known or suspected infection. The body may develop this inflammatory response by the immune system to microbes in the blood, urine, lungs, skin, or other tissues...
with peripheral necrosis
Neoplasm
- Cancerous bone or soft tissue tumors (e.g. osteosarcomaOsteosarcomaOsteosarcoma is an aggressive cancerous neoplasm arising from primitive transformed cells of mesenchymal origin that exhibit osteoblastic differentiation and produce malignant osteoid...
, osteochondromaOsteochondromaOsteochondroma is a type of benign tumor that consists of cartilage and bone. It is a benign capped-cartilage outgrowth, connected to bone by a stalk.It is the most frequently observed neoplasm of the skeleton....
, fibrosarcomaFibrosarcomaFibrosarcoma is a malignant tumor derived from fibrous connective tissue and characterized by immature proliferating fibroblasts or undifferentiated anaplastic spindle cells.Usually in males ages 30 to 40. Originates in fibrous tissues of the bone. Invades long or flat bones such as femur, tibia,...
, epithelioid sarcomaEpithelioid sarcomaEpithelioid sarcoma is a rare mesenchymal soft tissue tumour with an epithelioid pattern. It often occurs in the extremities of young adults.-Diagnosis:...
, ewing's sarcoma, synovial sarcomaSynovial sarcomaA synovial sarcoma is a rare form of cancer which usually occurs near to the joints of the arm, neck or leg. It is one of the soft tissue sarcomas....
, sacrococcygeal teratomaSacrococcygeal teratomaSacrococcygeal teratoma is a teratoma located at the base of the coccyx . It is thought to be a derivative of the primitive streak.-Natural history:...
, liposarcomaLiposarcomaLiposarcoma is a malignant tumor that arises in fat cells in deep soft tissue, such as that inside the thigh or in the retroperitoneum.They are typically large bulky tumors which tend to have multiple smaller satellites extending beyond the main confines of the tumor.Liposarcomas, like all...
) - MelanomaMelanomaMelanoma is a malignant tumor of melanocytes. Melanocytes are cells that produce the dark pigment, melanin, which is responsible for the color of skin. They predominantly occur in skin, but are also found in other parts of the body, including the bowel and the eye...
Trauma
- Severe limb injuriesInjury-By cause:*Traumatic injury, a body wound or shock produced by sudden physical injury, as from violence or accident*Other injuries from external physical causes, such as radiation injury, burn injury or frostbite*Injury from infection...
in which the limb cannot be spared or attempts to spare the limb have failed - TraumaticPhysical traumaTrauma refers to "a body wound or shock produced by sudden physical injury, as from violence or accident." It can also be described as "a physical wound or injury, such as a fracture or blow." Major trauma can result in secondary complications such as circulatory shock, respiratory failure and death...
amputation (an unwanted amputation that occurs at the scene of an accident, where the limb is partially or wholly severed as a direct result of the accident, for example a fingertip that is cut off by a meat grinder). - Amputation in utero (Amniotic band)
Deformities
- Deformities of digits and/or limbs
- Extra digits and/or limbs (e.g. polydactylyPolydactylyPolydactyly or polydactylism , also known as hyperdactyly, is a congenital physical anomaly in humans, dogs, and cats having supernumerary fingers or toes....
)
Athletic performance
- Sometimes professional athletes may choose to have a non-essential digit amputated to relieve chronic pain and impaired performance. Australian Rules footballer Daniel ChickDaniel ChickDaniel Chick is a professional Australian rules footballer who played for Hawthorn and the West Coast Eagles in the Australian Football League. Chick is also well known for having a finger amputated in 2002 so he could continue playing football.- Hawthorn career :Chick made his debut for Hawthorn...
elected to have his left ring fingerRing fingerThe ring finger is the fourth digit of the human hand, and the second most ulnar finger, located between the middle finger and the little finger. It is also called digitus medicinalis, the fourth finger, digitus annularis, digitus quartus, or digitus IV in anatomy.- Etymology :According to László A...
amputated as chronic pain and injury was limiting his performance. Rugby unionRugby unionRugby union, often simply referred to as rugby, is a full contact team sport which originated in England in the early 19th century. One of the two codes of rugby football, it is based on running with the ball in hand...
player Jone TawakeJone TawakeJone Tawake , , is a Fijian born rugby union player. He currently competes in the Super 14 competition and plays for the ACT Brumbies as a flanker and no.8. He formerly played for the New South Wales Waratahs...
also had a finger removed. NFL safetySafetySafety is the state of being "safe" , the condition of being protected against physical, social, spiritual, financial, political, emotional, occupational, psychological, educational or other types or consequences of failure, damage, error, accidents, harm or any other event which could be...
Ronnie LottRonnie LottRonald Mandel "Ronnie" Lott is a former American football player who starred as a cornerback, free safety, and strong safety in college football and the NFL. He is most well known for his crushing hits on opposing players...
had the tip of his little finger removed after it was damaged in the 1985 NFL season1985 NFL seasonThe 1985 NFL season was the 66th regular season of the National Football League. The season ended with Super Bowl XX when the Chicago Bears defeated the New England Patriots.-Major rule changes:...
.
Legal punishment
- Amputation is used as a legal punishmentPhysical punishmentPhysical punishment is any form of penalty in a judicial, educational or domestic setting that takes a physical form, by the infliction on the offender of pain, injury, discomfort or humiliation...
in a number of countries, among them Iran, Yemen, Saudi Arabia, Sudan, and Islamic regions of Nigeria. .
Method
Ligature (medicine)
In surgery or medical procedure, a ligature consists of a piece of thread tied around an anatomical structure, usually a blood vessel or another hollow structure to shut it off. With a blood vessel the surgeon will clamp the vessel perpendicular to the axis of the artery or vein with a hemostat,...
the supplying artery
Artery
Arteries are blood vessels that carry blood away from the heart. This blood is normally oxygenated, exceptions made for the pulmonary and umbilical arteries....
and vein
Vein
In the circulatory system, veins are blood vessels that carry blood towards the heart. Most veins carry deoxygenated blood from the tissues back to the heart; exceptions are the pulmonary and umbilical veins, both of which carry oxygenated blood to the heart...
, to prevent hemorrhage (bleeding). The muscles are transected, and finally the bone
Bone
Bones are rigid organs that constitute part of the endoskeleton of vertebrates. They support, and protect the various organs of the body, produce red and white blood cells and store minerals. Bone tissue is a type of dense connective tissue...
is sawed through with an oscillating saw. Sharp and rough edges of the bone(s) are filed down, skin and muscle flaps are then transposed over the stump, occasionally with the insertion of elements to attach a prosthesis
Prosthesis
In medicine, a prosthesis, prosthetic, or prosthetic limb is an artificial device extension that replaces a missing body part. It is part of the field of biomechatronics, the science of using mechanical devices with human muscle, skeleton, and nervous systems to assist or enhance motor control...
.
Prevention
Amputations are traumatic experiences that reduce the quality of life for patients in addition to being expensive. A typical prosthetic limb costs in the range of $10,000-15,000 in the USA according to the American Diabetic Association while it's practically free in the European countries. Preventing amputations is a critical task.Methods in preventing amputation depend on the problems that might cause amputations to be necessary. Chronic infections, often caused by diabetes or decubitus ulcers in bedridden patients, are common causes of infections that lead to gangrene, which would then necessitate amputation.
There are two key challenges: first, many patients have impaired circulation in their extremities, and second, they have difficulty curing infections in limbs with poor vasculation (blood circulation).
Various approaches have been attempted to work around these problems, including hyperbaric oxygen therapy
Hyperbaric oxygen therapy
Hyperbaric medicine, also known as hyperbaric oxygen therapy , is the medical use of oxygen at a level higher than atmospheric pressure. The equipment required consists of a pressure chamber, which may be of rigid or flexible construction, and a means of delivering 100% oxygen...
(HBOT) and low powered lasers. HBOT has proved to be particularly effective in revascularizing or rebuilding the smaller blood vessels in extremities and, as a result, preventing deterioration of the tissue and resulting infections. At the same time, delivering oxygen under pressure in a hyperbaric chamber increases oxygenation by up to 400 times in the blood, speeding up healing processes and killing off anaerobic bacteria (gas gangrene), the source of infections. The general research conclusion is that around 80% of resistant diabetic infections can be cured with HBOT.
Crush injuries where there is extensive tissue damage and poor circulation also benefit from HBOT. The high level of oxygenation and revascularization speed up recovery times and prevent infections.
A study found that the patented method called Circulator Boot got significant results in prevention of amputation in patients of diabetes and arterioscleorosis. Another study found it also effective for healing limb ulcers caused by peripheral vascular disease. The boot checks the heart rhythm and compresses the limb between heartbeats; the compression helps cure the wounds in the walls of veins and arteries, and helps to push the blood back to the heart.
For victims of trauma, advances in microsurgery
Microsurgery
Microsurgery is a general term for surgery requiring an operating microscope. The most obvious developments have been procedures developed to allow anastomosis of successively smaller blood vessels and nerves which have allowed transfer of tissue from one part of the body to another and...
in the 1970's have made replantations of severed body parts possible.
Prognosis
The individual may experience psychological trauma as well as emotional discomfort. The stump will remain an area of reduced mechanical stability. Limb loss can present significant or even drastic practical limitations.A large proportion of amputees (50-80%) experience the phenomenon of phantom limb
Phantom limb
A phantom limb is the sensation that an amputated or missing limb is still attached to the body and is moving appropriately with other body parts. 2 out of 3 combat veterans report this feeling. Approximately 60 to 80% of individuals with an amputation experience phantom sensations in their...
s; they feel body parts that are no longer there. These limbs can itch, ache, burn, feel tense, dry or wet, locked in or trapped or they can feel as if they are moving. Some scientists believe it has to do with a kind of neural map that the brain has of the body, which sends information to the rest of the brain about limbs regardless of their existence. Phantom sensations and phantom pain may also occur after the removal of body parts other than the limbs, e.g. after amputation of the breast, extraction of a tooth (phantom tooth pain) or removal of an eye (phantom eye syndrome
Phantom eye syndrome
The phantom eye syndrome is a phantom pain in the eye and visual hallucinations after the removal of an eye .- Symptomatology :Many patients experience one or more phantom phenomena after the removal of the eye:...
).
A similar phenomenon is unexplained sensation in a body part unrelated to the amputated limb. It has been hypothesized that the portion of the brain responsible for processing stimulation from amputated limbs, being deprived of input, expands into the surrounding brain, (Phantoms in the Brain: V. S. Ramachandran and Sandra Blakeslee) such that an individual who has had an arm amputated will experience unexplained pressure or movement on his face or head.
In many cases, the phantom limb aids in adaptation to a prosthesis, as it permits the person to experience proprioception
Proprioception
Proprioception , from Latin proprius, meaning "one's own" and perception, is the sense of the relative position of neighbouring parts of the body and strength of effort being employed in movement...
of the prosthetic limb. To support improved resistance or usability, comfort or healing, some type of stump sock
Stump sock
Stump socks are tubular medical or clothing accessories with a blind end that are fashioned similar to socks, usually without a heel. They are worn on amputation stumps for a number of reasons...
s may be worn instead of or as part of wearing a prosthesis.
Another side effect can be heterotopic ossification
Heterotopic ossification
Heterotopic ossification is the process by which bone tissue forms outside of the skeleton.-Diagnosis:During the early stage, an x-ray will not be helpful because there is no calcium in the matrix...
, especially when a bone injury is combined with a head injury. The brain signals the bone to grow instead of scar tissue to form, and nodules and other growth can interfere with prosthetics and sometimes require further operations. This type of injury has been especially common among soldiers wounded by improvised explosive device
Improvised explosive device
An improvised explosive device , also known as a roadside bomb, is a homemade bomb constructed and deployed in ways other than in conventional military action...
s in the Iraq war.
Due to technologic advances in prosthetics, amputees can live active lives with little restriction. Organizations such as the Challenged Athletes Foundation
Challenged Athletes Foundation
The Challenged Athletes Foundation is an organization that provides grants for training, competition and equipment needs to people with disabilities.- History :The Challenged Athletes Foundation was founded in 1997....
have been developed to give amputees the opportunity to be involved in athletics and adaptive sports such as Amputee Soccer
Team Zaryen
is a Haitian Amputee soccer team, located in Port Au Prince, Haiti. Zaryen is the Creole word for Tarantula.When asked why the tarantula was chosen to represent the soccer team the players give two answers. First because when a tarantula attacks, it pursues its enemy slowly and is deadly with just...
.
History
The word amputation is derived from the LatinLatin
Latin is an Italic language originally spoken in Latium and Ancient Rome. It, along with most European languages, is a descendant of the ancient Proto-Indo-European language. Although it is considered a dead language, a number of scholars and members of the Christian clergy speak it fluently, and...
amputare, "to cut away", from ambi- ("about", "around") and putare ("to prune"). The Latin word has never been recorded in a surgical context, being reserved to indicate punishment for criminals. The English word "amputation" was first applied to surgery in the 17th century, possibly first in Peter Lowe's A discourse of the Whole Art of Chirurgerie (published in either 1597 or 1612); his work was derived from 16th century French texts and early English writers also used the words "extirpation" (16th century French texts tended to use extirper), "disarticulation
Disarticulation
In medical terminology, disarticulation is the separation of two bones at their joint, either naturally by way of injury or by a surgeon during amputation....
", and "dismemberment
Dismemberment
Dismemberment is the act of cutting, tearing, pulling, wrenching or otherwise removing, the limbs of a living thing. It may be practiced upon human beings as a form of capital punishment, as a result of a traumatic accident, or in connection with murder, suicide, or cannibalism...
" (from the Old French desmembrer and a more common term before the 17th century for limb loss or removal), or simply "cutting", but by the end of the 17th century "amputation" had come to dominate as the accepted medical term.
External links
- Philipose Vaidyar writes how a both-legs amputee in Champa, India wins his bread
- Amputation from Cooper's 1835 "Practice of Surgery"
- Imaging of Lower Extremities Amputations