Amputation is the removal of a body part, usually an extremity. Amputation of a lower extremity has been often necessary because of progressive
peripheral vascular disease (often a sequel of diabetes mellitus), fulminating gas gangrene, trauma (crushing injuries, burns, frostbite, electrical burns), congenital deformities, chronic osteomyelitis or malignant tumor.
Amputation of the lower extremity accounts for more than a majority caused by peripheral vascular disease such as diabetes mellitus . Amputation of an upper extremity occurs less frequently than amputation of a lower extremity because of either traumatic injury or a malignant tumor. According to the National Lower Limb Information Center, it is estimated that 1 out of 200 people had experienced some form of amputation when they reach their middle adult life.
Rationale for Amputation
Amputation is primarily used as a last resort in relieving symptoms of a severe and morbid vascular disease condition, to improve function and most importantly to save or improve the individual’s quality of life. The main objective of surgical amputation is to conserve as much extremity length as needed to preserve function and possibly achieve a good prosthetic fit for limb prosthesis in the in the future. Most amputations involving extremities can be eventually fitted with a prosthetic device. If the health care team communicates a positive attitude, the patient can readily adjust to the amputation more readily and actively participates in the rehabilitative plan and can learn more beneficial techniques in modifying activities and more importantly how to use assistive devices for activities of daily living and mobility purposes.
Levels of Amputation
An amputation is performed at the most distal point that will heal successfully. The site of amputation is determined by two factors: circulation in the part and functional usefulness (meeting the requirements for the use of prosthesis). The circulatory status of an extremity is evaluated through physical examination and diagnostic studies. Muscle and skin perfusion is a very essential element in wound healing. Upper extremity amputations are performed with the goal of preserving the maximum functional length. The prosthesis is fitted as early as the wound heals in order to regain proper functioning and mobility.
A staged amputation may be used when gangrene and infection exists. Initially a guillotine amputation (non-closed stump) is performed to remove the necrotic and infected tissue. The wound is dèbrided and allowed to drain freely. Sepsis is treated with systemic antibiotics. In a few days after the infection is controlled and the patient’s condition has stabilized, a definitive amputation with skin closure is then performed.
Complications of Amputation
Complications that may occur with amputation include hemorrhage, infection skin breakdown, phantom limb pain and joint contracture. Because major blood vessels have been severed, massive bleeding may occur. Infection is a risk with all surgical procedures. The risk of infection increases with contaminated wounds following traumatic amputation. Skin irritation caused by prosthesis may result in skin breakdown. Phantom limb pain is caused by the severing of peripheral nerves. Joint contractures are caused
by positioning and protective flexion withdrawal pattern associated with pain and muscle imbalance. Complications of amputation procedures can be averted with proper use of sterile techniques by healthcare workers during the care of amputated limbs as well as informative dissemination of health instructions to the patient and family members in avoiding complications of amputations.