What’s an amputation?
Amputation is the loss or absence of all or part of a limb. An upper limb amputation involves the arm and/or hand. A lower limb amputation involves the leg and/or foot.
An acquired amputation means the limb is removed surgically because of disease or trauma. A congenital amputation means you’re born missing a limb.
Today, it’s more common to refer to a limb that’s been missing since birth as a “limb deficiency” or a “congenital anomaly,” rather than an “amputation.”
Why do people undergo amputation surgery?
Amputation surgery removes a limb that’s seriously threatening your life, but is performed only when other treatments aren’t working or possible.
Most amputations are performed because blood supply to the leg is blocked from a condition called peripheral vascular disease (PVD). Risk factors influencing PVD development include:
- High cholesterol
- Family history
When blood supply is reduced so severely that ulcers develop and won’t heal, infections set in, or gangrene develops, amputation may be the only option.
Serious accidents, trauma, or cancer can also lead to amputation. If a limb, or the blood supply to a limb, is damaged too severely, amputation may be necessary.
If you’re born with a limb deficiency, surgery to shorten or alter the residual limb may be necessary so you can be fitted with an artificial limb, called a prosthesis.
Chronic pain is rarely a reason for amputation. Many new pain management treatments are available that can control your pain better than removal of a limb.
How is the extent of an amputation determined?
If you have PVD, your surgeon determines where blood flow is most adequate to allow your amputation site to heal. Your surgeon will amputate as little of your limb as is medically necessary.
Surgeons will generally start with a limited amputation if there’s a chance of healing; but, be prepared to proceed to a major amputation if healing doesn’t occur.
If you’re expecting to use a prosthesis, the amputation site and technique used will make your limb best suited for a prosthesis fitting. The goal is to produce a good size residual limb that can tolerate the pressures of prosthesis use.
What are the most common amputation sites?
Common Lower Limb Amputations
Toe: Single or multiple toes are amputated.
Toe and ray: A toe and part of the corresponding foot bone is removed.
Partial foot: All of the toes and the ball of the foot are removed. This is also called forefoot, transtarsal, or choppart amputation.
Symes: The entire foot is removed through the ankle joint. The fatty heel pad is preserved for cushioning.
Below-knee or trans-tibial: The bones in the lower leg (tibia and fibula) end about 12-15 centimeters below the knee joint. Usually a muscle flap from the calf is brought up and over the end of the bone to provide cushioning. Some have an Ertl procedure where a bone bridge is created between the ends of the tibia and fibula, which may help patients tolerate more weight bearing pressure on the end of the limb.
Knee disarticulation (Gritti-Stokes amputation): The lower leg is removed through the knee joint. The knee doesn’t function as a hinge so this kind of amputation functions as an above-knee amputation.
Above-knee or trans-femoral amputation: The thigh bone (femur) ends about 12 to 15 centimeters above the knee joint. The muscle and skin are closed over the end of the bone to produce a cushioning effect.
Hip disarticulation: The leg is removed fully, from the femur down, leaving the pelvis intact.
Hemi-pelvectomy: Approximately half of the pelvis is removed, along with the entire leg.
Common Upper Limb Amputations
Finger/digit: Part or all of one or more finger(s) are removed.
Wrist disarticulation or hand: The hand is removed through the wrist joint.
Below-elbow or trans-radial: The hand and lower arm are removed through the forearm bones (radius and ulna).
Elbow disarticulation: The lower arm and hand are removed through the elbow joint. The elbow doesn’t function as a hinge; this amputation functions as an above-elbow amputation.
Above-elbow or trans-humeral: The arm is removed through the upper arm bone (humerus).
Shoulder disarticulation: The arm is removed at the shoulder joint; the shoulder joint doesn’t function.
Forequarter or intrascapulathoracic amputation: The arm, shoulder blade (scapula), and part or all of the clavicle are removed.
Causes of amputation:
- 82% poor circulation
- 22% trauma
- 4% congenital (born with the limb deficiency)
- 4% cancer
Of the amputations from poor circulation, 97% involve the lower limb:
- 25.8% above knee
- 27.6% below knee
- 42.8% other levels (toe, foot)
In trauma-related amputations, the upper limb is involved 68.6% of the time.
In cancer-related amputations, the lower limb is involved 76.1% of the time.
Congenital limb deficiencies occur at a rate of 26 per 100,000 live births. The upper limb is involved in congenital amputations at a rate of 58.5%.