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Amputation

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File:Amputee.jpg
Partial hand amputation
For the song "Amputations" by Death Cab for Cutie, see You Can Play These Songs with Chords

Amputation is the removal of a body extremity by trauma (also referred to as avulsion) or surgery. A special case is the congenital amputation, a congenital disorder, where foetal limbs have been cut off by constrictive bands. As a surgical measure, it is used to control pain or a disease process in the affected limb, such as malignancy or gangrene. In some cases, it is carried out on individuals as a preventative surgery for such problems. In some countries, amputation of the hands or feet is sometimes used as a form of punishment for criminals. In some cultures and religions, minor amputations or mutilations are considered a ritual accomplishment.

Types

Types of amputation include:

  • leg
    • amputation of digits
    • partial foot amputation (Chopart, Lisfranc)
    • ankle disarticulation (Syme, Pyrogoff)
    • below-knee amputation (transtibial)
    • knee-bearing amputation (knee disarticulation)
    • above knee amputation (transfemoral)
    • Van-ness rotation (Foot being turned around and reattached to allow the ankle joint to be used as a knee.)
    • hip disarticulation
    • hemipelvectomy
  • arm
    • amputation of digits
    • metacarpal amputation
    • wrist disarticulation
    • forearm amputation (transradial)
    • elbow disarticulation
    • above-elbow amputation (transhumeral)
    • shoulder disarticulation and forequarter amputation
  • teeth

Hemicorporectomy, or amputation at the waist, is the most radical amputation.

Genital modification and mutilation may involve amputating tissue(as the case is with circumcision), although not necessarily as a result of injury or disease.

As a rule, partial amputations are preferred to preserve joint function, but in oncological surgery, disarticulation is favored.

Reasons for amputation

  • Cancerous bone tumours (e.g. osteosarcoma, osteochondroma)
  • Severe limb injuries in which the limb cannot be spared or attempts to spare the limb have failed
  • Circulation problems
  • Deformities of digits and/or limbs
  • Any advanced cancers
  • Gangrene
  • Bone infection (osteomyelitis)
  • Traumatic amputation (Amputation occurs actually at scene of accident, the limb can be partially or wholly severed)
  • Amputation in utero (Amniotic band)
  • Mastectomy (amputation of breast) for breast cancer

Method

Curved knives such as this one were used, in the past, for some kinds of amputations.

The first step is ligating the supplying artery and vein, to prevent hemorrhage. The muscles are transected, and finally the bone is sawed through with an oscillating saw. Skin and muscle flaps are then transposed over the stump, occasionally with the insertion of elements to attach a prosthesis.

Self-amputation

In some rare cases when a person has become trapped in a deserted place, with no means of communication or hope of rescue, the victim has amputated his own limb:

  • In 2003, 27-year old Aron Ralston amputated his forearm using his pocketknife and breaking and tearing the two bones, after the arm got stuck under a boulder when hiking in Utah.
  • Also in 2003, an Australian coal miner amputated his own arm with a Stanley knife after it became trapped when the front-end loader he was driving overturned three kilometers underground. [1]
  • In the 1990s, a crab fisherman got his arm caught in the winch during a storm and had to amputate it at the shoulder, as reported in The New Englander.

Even rarer are cases where self-amputation is performed for criminal or political purposes:

  • Documentary filmmaker Errol Morris was ordered to "leave town within twenty-four hours or leave in a casket" by the unnamed "king of the nubbies" of the town of Vernon, Florida (which Morris called "Nub City"), when he was researching a documentary about a bizarre scam wherein individuals would cut off their own limbs as a way to collect insurance money.[2] The final version of Vernon, Florida contains no references to this scam.
  • On March 7 1998, Daniel Rudolph, the elder brother of the 1996 Olympics bomber Eric Robert Rudolph, videotaped himself cutting off one of his own hands with an electric saw in order to "send a message to the FBI and the media." [3]

After-effects

A large proportion of amputees (50-80%) experience the phenomenon of phantom limbs;[1] 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.

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. This type of injury has been especially common among soldiers wounded by improvised explosive devices in the occupation of Iraq. [4]

References

  1. ^ Heidi Schultz (2005). "Phantom Input". National Geographic Magazine. {{cite journal}}: Cite has empty unknown parameter: |1= (help); More than one of |work= and |journal= specified (help); Unknown parameter |month= ignored (help)

See also

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