AMPUTATIONS- Definition, Types, procedures, indications

Amputation is a surgical procedure involving the removal of a limb or part of a limb due to various medical conditions, trauma, or disease. Here’s an overview of the types, reasons, and considerations associated with amputations.

Types of Amputations

1. Upper Extremity Amputations:
- partial Hand Amputation: Removal of part of the hand.
- Wrist Disarticulation: Amputation at the wrist joint.
- Trans-radial Amputation: Below-elbow amputation.
- Elbow Disarticulation: Removal through the elbow joint.
- Trans-humeral Amputation: Above-elbow amputation.
- Shoulder Disarticulation: Removal at the shoulder joint.
- Forequarter Amputation: Removal of the entire arm and shoulder girdle.

2. Lower Extremity Amputations:
- Toe Amputation: Removal of one or more toes.
- Partial Foot Amputation: Includes procedures like Chopart or Lisfranc amputations.
- Syme's Amputation: Ankle disarticulation with preservation of the heel pad.
- Below-knee Amputation (BKA): Removal below the knee.
- Above-knee Amputation (AKA): Removal above the knee.
- Hip Disarticulation: Removal at the hip joint.
- Hindquarter Amputation: Removal of the leg along with part of the pelvis.

Reasons for Amputation

- Severe Infection- Infections that do not respond to treatment, such as gangrene or necrotizing fasciitis.
- Trauma- Severe injuries from accidents, such as crush injuries or blast wounds.
- Peripheral Arterial Disease (PAD): Poor circulation leading to tissue death due to lack of blood flow.
- Malignant Tumors: Cancerous growths in bones or muscles that necessitate removal.
- congenital Conditions: Limb deficiencies or deformities present at birth.

Surgical Procedure

- The procedure can be performed under general anesthesia or regional anesthesia, depending on the type and location of amputation.
- Surgeons aim to remove all diseased tissue while preserving as much healthy tissue as possible for prosthetic fitting later on.
- Techniques include smoothing bone edges and suturing muscles to ensure a strong stump for future prosthetic use.

Recovery and Rehabilitation

- Recovery time varies based on the type of amputation and individual health status. Hospital stays can range from several days to weeks.
- Patients often undergo physical therapy to adapt to their new circumstances and learn to use prosthetic limbs if applicable.
- Pain management is crucial, as many individuals experience stump pain or "phantom limb" sensations post-surgery.

Complications

Amputations carry risks, including:
- Infection at the surgical site
- Delayed wound healing
- Phantom limb pain
- Psychological impacts, such as grief over limb loss
- Potential cardiovascular complications due to pre-existing health condition

1. Amputation

General Definition
Amputation refers to the surgical removal of a limb or part of a limb. The
procedure can be performed on various body parts, including arms, legs, hands,
feet, and even fingers or toes. The primary goal of amputation is to eliminate
diseased or damaged tissue while preserving as much healthy tissue as possible.
Specific Definitions
- Major Amputation: Involves the removal of a significant portion of a limb (e.g.,
above-knee or below-knee amputation).
- Minor Amputation: Refers to the removal of digits (fingers or toes) or smaller
parts of limbs.
- Disarticulation: The surgical separation of two bones at their joint (e.g., wrist
disarticulation).
- Hemipelvectomy: The removal of a leg along with part of the pelvis.
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2. Types of Amputation
Amputations can be categorized based on their location and extent. Here are the
primary types:
Upper Limb Amputations
1. Partial Hand Amputation: Removal of part of the hand.
2. Wrist Disarticulation: Removal of the hand at the wrist joint.
3. Transradial Amputation: Below-elbow amputation.
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3. 4. Elbow Disarticulation: Removal at the elbow joint.
5. Transhumeral Amputation: Above-elbow amputation.
6. Shoulder Disarticulation: Removal at the shoulder joint.
7. Forequarter Amputation: Removal of the arm and part of the shoulder girdle.
Lower Limb Amputations
1. Toe Amputation: Removal of one or more toes.
2. Partial Foot Amputation: Involves various techniques depending on which part
of the foot is removed.
3. Ankle Disarticulation (Syme's): Removal at the ankle joint while preserving the
heel pad for weight-bearing.
4. Transtibial Amputation (Below-Knee): Removal between the knee and ankle.
5. Knee Disarticulation: Removal at the knee joint.
6. Transfemoral Amputation (Above-Knee): Removal between the hip and knee.
7. Hip Disarticulation: Removal at the hip joint.
8. Hemipelvectomy (Hindquarter Amputation): Removal of an entire leg along
with part of the pelvis.
Other Types
- Hemicorporectomy: Removal at the waist level.
- Decapitation: Removal at the neck.

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4. Classifications of Amputations
Amputations can be classified based on various criteria:
1. Anatomical Classification
- Upper Limb vs. Lower Limb: As discussed earlier, amputations can be
categorized based on whether they occur in upper or lower limbs.
2. Level of Amputation
- This classification considers how much of a limb is removed:
- Minor (digits)
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5. - Major (above-knee or below-knee)
3. Surgical Technique
- Techniques may include:
- Standard amputation
- Osseointegration
- Flap techniques (anterior/posterior)
4. Cause of Amputation
- Traumatic
- Medical conditions (e.g., diabetes-related)
- Congenital deformities
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6. Indications for Amputation
The decision to perform an amputation is based on several clinical indications:
1. Trauma
Severe injuries from accidents that result in irreparable damage to limbs often
necessitate amputation to prevent complications like infection or gangrene.
2. Vascular Disease
Conditions such as peripheral artery disease and diabetes can lead to poor blood
flow and subsequent tissue death (necrosis), making amputation necessary to
preserve overall health.
3. Tumors
Malignant tumors in bones or soft tissues may require amputation as part of cancer
treatment to prevent metastasis.
4. Infection
Severe infections that do not respond to antibiotics may require amputation to
prevent systemic infection (sepsis).
5. Congenital Deformities
Some congenital conditions may necessitate amputation if they severely affect
function or quality of life.
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7. Methods of Amputation
The surgical methods employed in amputations vary based on factors such as
location and underlying condition:
General Principles
1. Preoperative Assessment: Comprehensive evaluation including imaging studies
and discussions about anesthesia options.
2. Anesthesia Administration: Typically general anesthesia is used during major
amputations.
3. Incision Planning: Surgeons plan incisions based on anatomical landmarks to
minimize trauma to surrounding tissues.
Specific Techniques
Upper Limb Techniques
1. Transradial Amputation
- Incision made around the forearm; muscles anchored to bone ends; skin closed
over stump.
2. Elbow Disarticulation
- Joint surfaces are separated; muscles are anchored similarly; skin closure
follows.
3. Shoulder Disarticulation
- Entire arm removed; careful dissection around major blood vessels; skin
closure over stump.
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8. Lower Limb Techniques
1. Transtibial Amputation
- Incision made just below the knee; tibia and fibula cut; muscles anchored; skin
closed in layers.
2. Knee Disarticulation
- Joint surfaces separated; ligaments preserved where possible; skin closure
follows.
3. Transfemoral Amputation
- Above-knee incision; femur cut; muscles anchored for prosthetic fitting; skin
closed over stump.
4. Syme’s Amputation
- Ankle disarticulated while preserving heel pad; allows for weight-bearing post-
surgery.
5. Hemipelvectomy
- Extensive surgery involving removal at pelvic level; requires careful
management of surrounding structures.
Advanced Techniques
1. Osseointegration
- Involves placing an implant into residual bone allowing direct attachment for
prosthetics; promotes better weight distribution during ambulation.
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9. 2. Flap Techniques
- Utilizes skin flaps to cover bone ends effectively while minimizing scar tissue
formation; enhances healing process.
Postoperative Care and Rehabilitation
Postoperative care following an amputation is crucial for successful recovery:
Pain Management
1. Residual Limb Pain
- Managed through medications like NSAIDs or opioids as needed.

2. Phantom Limb Pain
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10. - Often requires specific therapies including medications like gabapentin or
physical therapy approaches aimed at desensitization.
Wound Care
Proper wound care protocols must be followed to prevent infection:
- Regular dressing changes
- Monitoring for signs of infection
- Maintaining cleanliness around surgical site
Rehabilitation
Rehabilitation plays a vital role in helping patients adapt post-amputation:
1. Physical Therapy
- Focuses on restoring mobility and strength in remaining limbs.

2. Occupational Therapy
- Aims to help patients regain independence in daily activities using adaptive
techniques or devices.
3. Prosthetic Fitting
- Involves assessing residual limb shape and size for appropriate prosthetic fitting
once healing has progressed sufficiently.
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11. Psychological Considerations
The psychological impact following an amputation can be significant:
1. Emotional Support
- Counseling services should be provided to help patients cope with loss and
adjust emotionally.

2. Support Groups
- Connecting with other amputees can provide valuable emotional support
through shared experiences.
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