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Amputation Health Article
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DefinitionAmputation is the intentional surgical removal of a limb or body part. It is performed to remove diseased tissue or relieve pain. PurposeArms, legs, hands, feet, fingers, and toes can all be amputated. Most amputations involve small body parts such as a finger, rather than an entire limb. More than 60, 000 amputations are performed in the United States each year. Amputation is performed for the following reasons:
The blood supply to an extremity can be cut off because of injury to the blood vessel, hardening of the arteries, arterial embolism, impaired circulation as a complication of diabetes mellitus, repeated severe infection that leads to gangrene, severe frostbite, Raynaud's disease, or Buerger's disease. More than 90% of amputations performed in the United States are due to circulatory complications of diabetes, the most common cause of non-traumatic leg and foot amputations. PrecautionsAmputation cannot be performed on patients with uncontrolled diabetes mellitus, heart failure, or infection, and is also inadvisable for patients with blood clotting disorders. DescriptionAmputations 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 is to be removed. The goal of all amputations is twofold: 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 then closed over the bone with sutures (surgical stitches) that remain in place for 3 to 4 weeks. Often, a rigid dressing or cast is applied that stays in place for about two weeks. PreparationBefore 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
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 the following can be done to help choose the proper level of amputation:
No one test is highly predictive of healing, but taken together, the results can give the surgeon a detailed idea of the best place to amputate. AftercareAfter amputation, medication is prescribed for pain, and patients are treated with antibiotics to discourage infection. The stump is moved often to encourage good circulation. Physical therapy and rehabilitation are started
Recovery from surgery takes about six weeks. Rehabilitation, however, is a long and arduous process, especially for above-the-knee amputees. The doctor and physical therapist decide how soon after surgery the patient can begin to exercise, and several sessions each day may be recommended. In addition, psychological counseling is an important part of rehabilitation. Many patients experience a sense of loss and grief when they lose a 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 the limb that has been removed. Many amputees benefit from joining self-help groups and meeting others who are also living with amputation. Addressing the emotional aspects of amputation often speeds the physical rehabilitation process. |
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