Amputation and prosthetic limbs

Amputation surgery

An amputation surgery is performed to remove a limb or part of it for some medical reason. The patient may need a prosthetic limb after the amputation, so the surgery is done accurately in Turkey.

causes of amputation

Amputation is done as a last treatment option when no other methods are available to treat one of the following causes:

  • The limb is not supplied with enough oxygen which lead to necrosis.
  • complications of diabetes is One of the most common causes of amputation, especially for the footdue to diabetic arterial dysfunction, which causes poor blood flow, in addition to neuropathy associated with diabetes, which causes poor sensations from foot which leads to wounds and ulcers.
  • Severe infections that spread to the rest of the body if the limb is not amputated, such as gangrene.
  • Severe traumatic injuries such as car accidents or burns.
  • Some malignant tumors spread to muscle tissue and limb bones.
  • Peripheral arterial disease (PAD), which causes poor blood flow through the arteries to the extremities.
  • Forest bite also causes poor blood flow and limb necrosis.
  • Large wounds and sores that do not heal.
  • Limb deformities that affect the movement and function of the limb.

Types of amputation

The amputation surgery might be done at the upper limb or the lower limb, or both, and the amputation may be limited to one part of the limbs (hand, foot, leg, forearm, fingers).

Amputations performed at the lower limb are much more common than those performed at the level of the upper limb. According to a study conducted in the United States of America, only 3% amputations were performed at the upper limb.

levels of lower limp amputation are:
  • Amputation of the foot or toes.
  • Amputation of the lower limb below the level of the ankle, i.e. amputation of the foot from the ankle joint downward.
  • Below-knee amputation, the lower limb is amputated just below the knee joint.
  • Knee disarticulation is the amputation of the lower end of the knee joint.
  • Above-knee amputation, the lower limb is amputated above the knee joint.
  • Hip disarticulation: The entire lower limb is amputated from the hip joint.
  • Trans-pelvic disarticulation: This method involves the complete amputation of the lower limb with the removal of the pelvic bone.
A picture of the lower limbs in humans showing the levels of the amputation process
Lower limb amputations are common, especially due to diabetes, and the doctor chooses the level of amputation according to the extent of the necrotic tissues
Levels of upper limp amputation are:
  • Amputation of the hand or fingers.
  • Amputation at the level of the wrist disarticulation.
  • Below-the-elbow amputation
  • Elbow disarticulation, the lower part of the arm is amputated and separated from the upper part, the ulna and radius are amputated.
  • Above-elbow amputation, the lower arm is amputated in addition to the elbow and part of the upper arm where the surgical incision are made through the humerus.
  • Shoulder disarticulation The arm is completely amputated at the shoulder level.
  • Forequarter amputation: In this type, the entire upper limb is amputated, in addition to a portion of the shoulder.
Picture of the levels of the amputation process in the upper extremity
Amputation levels in the upper extremities and amputations of the upper extremities are uncommon compared to amputations of the lower extremities

before the amputation

The amputation may be performed as an emergency (as in a motor vehicle accident or burn), or can be performed as a scheduled non-emergency procedure (as in the case of peripheral arterial disease, sepsis, or cancer).

if the amputation is decided to be done as a non-emergency, the doctor examines the patient to ensure that the patient is able to undergo this surgery. The cardiovascular system is examined in addition to the respiratory function.

The doctor also check the healthy contralateral limb, in order to ensure the contralateral limb’s ability to bear the burden that will be added to it as a result of the amputation of the other limb.

After confirming the patient's health, the orthopedic surgeon explains the method of performing the amputation that suits the patient's condition. The healthy tissue is preserved as much as possible, in addition to performing the surgery in a way that enables the patient to install an alternative prosthesis in that area.

Special attention should be given to the psychological aspect, as the loss of a limb is not easy for the patient and may have severe psychological consequences that affect the patient’s life after the surgery.

Before the amputation, the patient is introduced to the physical therapist who will provide assistance to the patient after the amputation, in addition to the prosthetist who works to advise the patient in choosing and installing prostheses that suit his condition.

What happens during amputation surgery? 

The main goal of amputation is to remove diseased tissue and preserve healthy tissue as much as possible.

When the decision to amputate is made, doctors study the possible consequences of the surgery on the patient's ability to move the limb and feel it, in addition to the aesthetic results.

The patient is given either general anesthesia or spinal anesthesia, depending on the level of amputation. After that, a surgical incision is made and the damaged tissue is removed by amputating the affected part of the limb with a surgical scalpel.

The surgeon smoothes the bone areas and close the vessels and nerves tightly, and also works to cut the muscles and prepare them for installing the prosthesis in its place, after which the wound is bandaged with a sterile dressing.

The amputation surgery usually takes about 45 to 90 minutes, The duration of the patient staying at the hospital after the surgery depends on the type of amputation that was performed, but the patient often stays about 4 to 14 days after the surgery in order to evaluate his condition and ensure that there is no Presence of complications resulting from surgery.

Recovery after amputation

The first day after the surgery is the most difficult day for the patient. What was just hypotheses yesterday has become a reality that the patient must live with for the rest of his life. Losing a limb is somewhat like losing a close family member.

The hospital staff monitors the wound resulting from the surgery, and the dressings are changed from time to time. Painkillers and sedatives are prescribed after the surgery, and antiseptics may be prescribed to prevent infection. After the surgery, the patient is provided with oxygen through a mask, and a urinary catheter is also placed for the patient to avoid the need to go to the bathroom so that the patient stays still and the wound will heal quicker.

After the surgery, some patients suffer from a phenomenon called phantom pain, in this case the pain or sensation is felt in the amputated limb that does not exist in the first place. This phenomenon is common among patients after the amputation surgery for a reason that is not fully understood.

Some believe that the reason for this phenomenon is due to psychological reasons, while some doctors explained the cause for this phenomenon by the random mixed response of the brain after the amputation surgery, as the nerves responsible for the amputated limb are alerted.

The patient begins to receive natural therapy A few days after the amputation in order to move the body and limbs and prevent blood clots as a result of prolonged stay in bed during recovery to ensure wound healing.

Physiotherapy continues after the wound has healed, the physiotherapist helps the patient to maintain the normal range of motion in the amputation sites in addition to stretching exercises, the physiotherapist also gives instructions and advice after the amputation surgery to the patient, so physiotherapy is a lengthy rehabilitation process that may take a number of months or up to years.

The wound heals completely after the surgery by about 4 to 8 weeks. There are factors that delay wound healing such as the presence of chronic diseases such as diabetes or smoking. The prosthesis can be fitted after the wound has healed well. The prosthesis technician works side by side with the physical therapist during the rehabilitation.

The recovery and rehabilitation phase may take a long time for the patient to get used to his new life. The rehabilitation team consists of a physiotherapist, a surgeon, in addition to a psychiatrist who helps the patient during his recovery. Prosthetics fitting can be perform after amputation.

Risks of Amputation 

No surgical procedure is completely free of risks. The amputation surgery may be associated with complications that may result either from the surgical procedure or because of the effect of amputating the limb on the body. We mention some of the complications:

  • Infection at the site of the wound
  • Delayed wound healing
  • Venous thrombosis (DVT) due to blood clots at the site of a limb amputation
  • pneumonia (infection of the lungs)
  • phantom pain in amputated limb
  • Heart problems such as sudden stroke

What is prosthetics?

Prostheses are devices that replace amputated limbs, both shapely and functionally.

Not every person who has undergone an amputation is able to install prostheses, there are a number of factors that play a role in this matter, and the presence of sufficient soft tissue in order to place the prosthesis is important in addition to the patient's general health condition.

The installation of the prosthetic limb requires the patient to undergo prolonged physical therapy sessions. if the patient is unable to do so, it is preferable not to put the prosthetic limb.

Decision of Installation of prostheses Depend on the type of amputation that was performed, for example, the amputation that takes place at the level below the knee is a good candidate for placing prostheses, in contrast to the amputation that takes place above the knee level. The presence of the knee joint facilitates the process of installing prostheses in that area.

The patient's motor activity plays a role in this matter, as the patient with little physical activity will find it more difficult to deal with the prosthesis compared to the athletic patient who was subjected to amputation for some reason.

There are different types of prostheses available, as there are prostheses for the hand and fingers, prostheses above the knee, and prostheses for amputations below the knee.

The rehabilitating of the prosthesis and adapting to it may take a long period of time until the person gets used to using the prosthesis well.

Image of a doctor fitting a prosthetic limb to a patient whose upper limb has been amputated
The installation of prosthetic limbs greatly helps the patient who has undergone a limb amputation in his working life, but the operation cannot be performed in all patients. However, the success rate in Istanbul is very large compared to other places.

Sources:

  1. NHS
  2. Orthopedic Medical Centre
  3. Cleveland Clinic

Common Questions

In some cases, doctors say that they have to perform an amputation on both sides for a medical reason. The reasons for amputation are:

In most cases, it is done under general anesthesia by a specialized doctor by cutting the affected part of the limb

There are a number of factors that contribute to the prevention of amputation, and in some cases a medical intervention may be performed to save a diabetic leg from amputation.

There are multiple effects associated with amputation, most of which are psychological related to the loss of the organ and differ from one patient to another.

A leg amputation surgery generally takes between one and two hours.

Diabetic leg or foot is amputated because of the dead tissue that contains bacterial infections, so it will not not move and cause larger cell death, which leads to larger tissue necrosis.

The duration of the surgery depends on the level of the amputation. The surgery usually takes about 45 to 90 minutes.

In some cases, scheduled or emergency amputation resulting from injuries and violent accidents may be associated with complications that cause death.

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