What isAmputations? Why is Amputation Necessary? What Happens During Amputation? Are There After Effects Following Amputation?

What is Amputations?

Amputation is an acquired condition that results in the loss of a limb, usually from injury, disease, or surgery. Congenital (present at birth) limb deficiency occurs when an infant is born without part or all of a limb. In the US, 82 percent of amputations are due to vascular disease, 22 percent to trauma, 4 percent are congenital, and 4 percent are due to tumors. According to the Agency for Healthcare Research and Quality (AHRQ), about 1.9 million individuals in the United States are living with an amputation, with approximately 113,000 lower limb amputations performed each year.

Peripheral arterial disease (PAD), due to atherosclerosis (hardening of the arteries), is the leading cause of amputation in people age 50 and older, and accounts for up to 90 percent of amputations. PAD causes the blood vessels in your limbs to become damaged because of hardening of the arteries or diabetes. Cells within your body depend on a constant supply of oxygen and nutrients delivered to them by your blood. If your blood vessels are unable to supply blood and oxygen to your fingers or toes, the cells and tissues die and are vulnerable to infection. If the blood supply cannot be improved sufficiently or if the tissue is beyond salvage, extensive tissue death may require amputation, especially if you are experiencing severe pain or infection.

A traumatic injury, such as a car accident or a severe burn, can also destroy blood vessels and cause tissue death. If infection is not adequately treated, it can spread through your body and threaten your life. The medical team will make every effort to save your limb by surgically replacing or repairing your damaged blood vessels or using donor tissue. If these measures do not work, amputation can save your life. Traumatic injuries are the most common reason for amputations in people younger than age 50.

A physician may recommend amputation if you have a cancerous tumor in your limb. Chemotherapy, radiation, or other treatments may be used to destroy the cancer cells. These treatments can shrink the tumor and may increase the effectiveness of your amputation.

What Happens During Amputation?

To perform an amputation, the physician must remove your diseased limb but preserve as much healthy skin, blood vessel, and nerve tissue as possible.

Choosing the incision site is crucial. If the surgeon removes too little tissue, your wound will not heal because unhealthy tissue remains and the circulation at that level may not be sufficient for healing. To determine how much tissue to remove, the physician will:

  • Check for a pulse at a level close to the site prior to the operation.
  • Compare the skin temperatures in the diseased limb with those in a healthy limb, and note places where the skin appears red, since an incision made through reddish skin may be less likely to heal.
  • Check that your skin around the proposed incision point still has sensitivity to touch.

After the physician makes the initial cut, he or she may decide that more of your limb needs to be removed if the edges of your skin do not bleed enough to allow them to heal.

Before the procedure begins, the anesthesiologist will either put you to sleep with a general anesthetic, or numb your body in the region of the amputation using a regional anesthetic. You will be connected to machines that monitor your heart rate, blood pressure, temperature and brain function. When the anesthetic has taken effect and you are not able to feel any pain, your surgeon will make an incision into your skin, leaving enough healthy skin to cover your stump for better healing.

When the surgeon divides the muscles, he or she may shape them, to make sure that your stump has a comfortable contour for your artificial limb. The surgeon also divides and protects your nerves, so that they are not exposed and painful.

During surgery, clamps are applied to healthy major blood vessels to minimize bleeding. Before finishing your amputation, the surgeon will stitch the vessels, and then release the clamps to ensure that all bleeding points are secure.

If you have a traumatic injury, the surgeon will remove the crushed bone and other tissue, a process called “debridement.” The surgeon then will smooth the uneven areas of your bone to prevent pain once you receive your artificial limb. If necessary, your surgical team may then install temporary drains that will drain blood and other fluids that may accumulate.

When the surgeon has removed the dead tissue, he or she may decide to leave the site open (open flap amputation) or to close the skin flaps (closed amputation). In an open flap amputation, your skin remains drawn back from the amputation site for several days so the surgical care team can clean off of any questionable or infected tissue. Once the stump tissue is clean and free of infection, the skin flaps are sewn together to close the wound in a procedure called “delayed closure.” In a closed amputation, the wound is sewn shut immediately. A closed amputation is usually done if the surgeon is reasonably certain that the chance of infection is small and healing is likely.

The surgical care team may place a stocking over your stump to hold drainage tubes and wound dressings, or your limb may be placed in traction, or a splint, depending upon your particular situation.

Are There After Effects Following Amputation?

A large proportion of amputees (50 to 80 percent) experience the phenomenon of phantom limbs, meaning they feel body parts that are no longer there. These limbs can itch, ache, and 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, actually expands into the surrounding brain, such that an individual who has had an arm amputated will experience unexplained pressure or movement on their face or head. The individual may also experience some trauma as well as emotional discomfort. In many cases, the phantom limb aids in adaptation to a prosthesis, as it permits the person to experience proprioception of the prosthetic limb.

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.