In the United States alone, approximately 185,000 amputations occur each year, and 2 million people are living with the loss of a limb. In recognition of Limb Loss Awareness Month, Yvonne Humphies, RN, BSN and Sarah Saxton, PT, DPT, amputation specialists at Sheltering Arms, answer questions about the process, from the reasons for amputation, to returning to favorite activities following surgery.
What are some reasons for amputation?
An amputation is the surgical removal of part of the body, usually an arm or leg. There are three main reasons for amputation.
- The limb has been affected by gangrene, which is when the body's tissue begins to die as a result of lack of blood supply.
- There has been a life-threatening danger to the person's health, such as when the part of the body has been affected by cancer or serious infection.
- The limb has experienced a serious trauma, such as an injury that has crushed the limb or a significant wound.
What are the different types of amputation?
There are many different types of amputation. The easiest way to explain is to divide them into lower limb and upper limb categories.
Lower limb amputations:
- A partial foot amputation involves the removal of one or more of the toes. This type of amputation affects walking and balance.
- Ankle disarticulation involves amputation of the foot at the ankle level.
- A below the knee (or transtibial) amputation is an amputation of the leg below the knee joint, so the individual retains use of the knee. This is the most common amputation in the older population.
- A through-the-knee empty amputation involves removal of the lower leg and the knee joint. The residual limb is still able to bear weight, as the whole femur (the longest bone in the leg) is still intact.
- In a hip disarticulation, the whole limb is removed, including the femur. When possible, a variation of this procedure is done to retain part of the upper femur and hip joint for better shape and profile when sitting.
- A trans-pelvis amputation (or hemipelvectomy) involves removal of the entire leg and part of the pelvis.
Upper limb amputations:
- A partial hand amputation can include fingertips or part of the fingers. The thumb is the most commonly lost digit, which limits grasping ability.
- A metacarpal amputation is the removal of the whole hand, leaving the wrist intact.
- Wrist disarticulation involves removing the hand on the wrist joint.
- A below elbow (or transradial) amputation involves removal of the forearm below the elbow joint.
- In elbow disarticulation, the forearm and the elbow joint are removed.
- Above the elbow (or transhumeral) amputation is the removal of the arm above the elbow.
- Shoulder disarticulation is the removal of the entire arm, including the shoulder blade and collarbone.
What can someone expect following an amputation?
Immediately following surgery, the focus is on healing the residual limb, which is paramount for long-term recovery goals. Healing of the wound at the amputation site typically occurs within 3-4 weeks. The scar takes significantly longer, approximately 12 to 18 months, to heal on the inside. Wound management during this early phase is very important to promote healing of the underlying soft tissue and to reduce the risk of infection. The goal is to maintain a soft, pliable tissue over the scar and shape it through compression to allow for a prosthesis and weight bearing moving forward.
Coming to terms with the psychological impact of an amputation is often as important as coping with the physical effects. It's very common to experience negative thoughts after an amputation, especially if it was done in an emergency situation without time to prepare for the effects of the surgery. Many people report feeling emotions of grief, similar to experiencing the death of a loved one. It is important to seek support from loved ones and professionals as needed to help in the process of emotional healing.
What is a prosthesis and how does it work?
A prosthesis is an artificial limb which is created by a certified prosthetist. The parts vary depending on the level of amputation and the mobility of the user. The rehabilitation team collaborates to ensure that the prosthetic user has the most appropriate prosthetic components to allow for optimal mobility and activity.
How does rehabilitation help?
Initially, pre-prosthetic training is conducted. This is the time period in which wound healing is occurring. The focus of interventions is on residual limb management, positioning, maintenance of range of motion, strengthening, and functional transfer training.
Once the wound has healed, prosthetic training with a temporary prosthesis typically occurs. Interventions address range of motion, strength, balance, endurance, and mobility. Throughout this time, adjustments may be necessary to the temporary prosthesis in order to optimize comfort.
The overall goal of rehabilitation is to ensure safety and provide as much independence as possible while achieving the highest level of functional mobility.
How long does the rehabilitation process take?
Rehabilitation needs vary widely from person to person. The rehabilitation team will help the prosthetic user set realistic goals to achieve throughout his/her personal plan of care.
Can people still participate in favorite activities following amputation?
Most activities can be completed with the use of a prosthesis. It is best to discuss returning to these activities with a skilled therapist and prosthetist if there is any concern for safety. If the limb that is worn for daily use is unable to tolerate certain activities, there are specialty prosthetics designed for specific activities like swimming, cycling, snow skiing/boarding, and water skiing/boarding. Sheltering Arms also offers adaptive sports programs, such as golf and bowling leagues. Click here for more information.
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