Amputation

Amputation Overview

Amputation of a body part is a "life-changing event." Body image, mood, mobility, ability to care for one's self, work, and non-work-related activities are all affected. Many issues arise following the loss of all or part of a person's limb(s); however, the long-term outcomes for amputees continue to improve.

Amputation Statistics

Although over 90% of limb loss is "acquired", up to 4% is congenital (present at birth). Of the roughly 185,000 amputation surgeries performed each year in the United States,

up to 90% are due to vascular disease (circulation problems), especially in people with diabetes, but also in non-diabetic smokers.
the remaining ~10% are needed, either after limb trauma or as part of the treatment for benign or malignant limb tumors.

While over 90% of amputations caused by vascular disease involve the lower limb, nearly 70% of amputations caused by trauma involve the upper limb. (Further statistics are available from resources such as the Amputee Coalition of America's National Limb Loss Information Center (NLLIC).)

Reducing the Need for Amputation

Ideally, the need for an amputation can be lessened by:

avoiding smoking properly managing such medical conditions as diabetes, high blood pressure, and high blood cholesterol
observing appropriate safety practices - particularly around moving machinery, but also when driving or riding in an automobile
treating infected wounds with antibiotics, hyperbaric oxygen (high pressure oxygen therapy), and local treatments.

Techniques used by vascular surgeons try to reduce the need for amputation byinclude:

removing a blood clot (thrombectomy or embolectomy),
opening up a narrowed blood vessel (angioplasty, usually with stenting to reduce the chance of recurrence), or
performing arterial bypass surgery.

Amputation surgery is only performed after a decision has been made that a person's overall level of function and quality of life will improve - rather than diminish - after amputation surgery and subsequent rehabilitation.

Visit Leg Artery Disease (Society for Vascular Surgery) for more information about these procedures.

Prosthetic Devices

In most, but not all, cases, a prosthesis (artificial limb) will enhance an amputee's mobility and self-care activities. A prosthesis should be comfortable, functional, and cosmetic. Training by a skilled physical and/or occupational therapist is necessary before and after receiving a prosthesis. This training will help to maximize functional use of the artificial limb. It will also prevent development of "bad habits" that may be difficult to break later.

Advances in medical treatments and surgical techniques continue. However, over the past 10 years, improved outcomes following amputation have largely been the result of advances in prosthetic technology. Consider the following examples.

For lower limb amputees:

The number of prosthetic feet that provide "dynamic response" and the ability to maneuver on uneven surfaces continues to increase. Also, at least one microprocessor-controlled prosthetic foot-ankle unit is now available.

For above-knee amputees:

There are currently at least 5 different prosthetic knee units that use "microprocessor-control." These units allow for more normal knee motion and stability through computerized parts that monitor motions and forces and make extremely rapid real-time adjustments while walking. This results in improved walking ability, requiring less effort.

For upper limb amputees:

The original available body-powered (cable-controlled) prosthetic designs remain in common use, are the most durable, and continue to improve. Although using electrical signals from the muscles (myoelectric componentry) to control prostheses for the upper limb has been in use for over 40 years, this technology continues to advance, with associated further enhancements in function. To improve the ability of high-level (close to or through the shoulder) upper limb amputees to use a myoelectric prosthesis, in 2006 a surgical technique called “targeted reinnervation” was introduced, where motor and sensory nerves are transferred to improve motor control and sensory feedback during prosthetic use. The application of this technique is still in the early stages.

Rehabilitation

Although these ongoing developments are exciting and expand the available treatment options, the most advanced prosthetic device may not be the most appropriate in every case. Optimal prosthetic rehabilitation is best provided through a coordinated team approach. Team members include:

the patient
family members
surgeon (usually vascular or orthopedic)
prosthetist
physiatrist (physician specializing in physical medicine and rehabilitation)
primary care physician
physical and/or occupational therapist
health care insurer

Additional team members often include:

mental health professional
social worker
employer
vocational rehabilitation specialist
peer counselor/support group.

Working together, these team members help the patient regain maximum function, independence, and quality of life.

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This article is a NetWellness exclusive. NetWellness Article

Last Reviewed: Nov 12, 2008

Brian L. Bowyer, MD
Associate Professor of Clinical PM&R
OSU Sports Medicine and Family Health Center
Department of Physical Medicine and Rehabilitation
College of Medicine
The Ohio State University