Amputation: Meaning, Types, Disability, Causes and Impact

Annually, 1 million people undergo limb amputation all over the world. And, this rate of amputation is on a gradual rise. Global amputation statistics are quite alarming. Someone somewhere in the world loses an entire limb or a part every 30 seconds. Shockingly, most of us do not get to know anything about amputation unless someone close to the heart has to undergo such a situation. In this article, we are providing a brief overview of amputation and its causes to help you develop a basic understanding of an issue that affects a significant portion of the human population.

What is Amputation?

Amputation may broadly mean the severing of a person’s hands or legs. This may be caused due to traumatic accidents, war injury or even acts of terrorism. But, to be specific, here we are discussing about amputation in medical terms. So, for our current use, amputation means surgical removal of a limb (or a part of a limb).

Amputation or removal of an extremity might be necessitated by an accident, trauma, prolonged constriction or a medical illness. This surgical process is almost always the last option or final method used by surgeons to save a patient’s life. But, it comes with its share of after-effects, mostly in the form of mental or emotional trauma. In the event of amputation, prosthetic limbs are often used to replace the severed natural limbs.

Types of Amputation

The type or level of amputation depends on the limb or extremity on which the surgery is performed. Broadly we classify them into two parts – Upper Limb Amputation and Lower Limb Amputation.

Upper Limb Amputation

• Forequarter Amputation – This means surgical removal of an entire arm along with the shoulder. In this surgery part of the shoulder blade and collarbone is also removed.
• Shoulder Disarticulation – When the entire hand is removed at the shoulder level, it is called shoulder disarticulation. This is a slightly lower level amputation than forequarter amputation.
• Trans-humeral Amputation (Above Elbow) – This is amputation of the upper-arm. The hand is amputated between the shoulder and the elbow. The person undergoing trans-humeral amputation will retain the use of her shoulder.
• Elbow Disarticulation – As the name suggests, this amputation is done at the elbow level.
• Transradial Amputation (Below Elbow) – This is the amputation of the forearm. The amputation is done between the elbow and the hand. The person retains the use of her elbow.
• Wrist Disarticulation – This amputation is done at the wrist joint.
• Metacarpal or Partial Hand Amputation – This amputation is done at the level that the wrist joint is left intact. In some cases, the hand is removed partially.
• Digit Amputation – This is the amputation where a person’s fingers or thumb are removed surgically. The digits may be removed entirely or the only tip may be amputated based on the patient’s need.

Lower Limb Amputation

• Hemipelvectomy (Pelvic/ Trans pelvic amputation) – This is one of the rare lower limb amputations. Up to half of the pelvis is removed. In some cases, part of the pelvis may be removed while the leg is saved and in some cases, the entire leg along with that side of the pelvis needs to be amputated.
• Hip Disarticulation – When the leg is amputated at the hip joint it is called hip disarticulation.
• Transfemoral Amputation (above the knee) – This is the amputation where the leg is severed at a point between the hip joint and knee joint. It is called transfemoral as the amputation is done through the femur or thigh bone. In this case, the amputee retains full use of the hip joint.
• Knee Disarticulation – Amputation done at the knee joint.
• Transtibial Amputation (below the knee) – When amputation is done at a point between knee and ankle, it is termed as transtibial or below the knee amputation. The person retains full use of the knee.
• Ankle Disarticulation – When amputation is done at the ankle joint, it is called ankle disarticulation. The foot of the amputee is removed.
• Partial Foot Amputation – The amputation where the ankle joint is left intact. The foot of the person is amputated partially.
• Digit Amputation – When one or more toe is removed surgically, it is called digit amputation.

Causes of Amputation

A surgeon may decide to amputate a person for various reasons. As discussed above, amputation is the last course of action for any given reason. So, none of the causes we are going to mention surely leads to amputation. The decision of amputation is taken keeping in view various aspects.
Some of the most common examples of the conditions where amputation becomes necessary are as follows –

• Peripheral arterial disease i.e. the condition where arteries get narrowed or damaged resulting in poor blood circulation in the limb
• Severe injury due to an accident
• Severe burn
• The cancerous tumor in the muscles or bones of the limbs
• Neuroma or thickening of the nerve tissue
• A serious infection that does not get better with any other treatment
• Frostbite
• Severe diabetes
• Gangrene
• Chronic ulcer leading to septicemia

Effects of Amputation

An amputation is a life-changing experience. Disability caused by amputation has effects on the person’s life are far-reaching. Amputation comes under the category of locomotor disability. However, the effect varies from person to person depending on various factors like – level of amputation, condition of the remaining limb, person’s age and pre-injury health condition etc. Moreover, a person’s emotional response to the amputation too plays a major role.

Some of the common effects of amputation can be listed as follows –

• Reduced balance and mobility – While talking about lower limb amputation, reduced balance and mobility is the first thing that comes to the mind. But, an upper limb amputation too may affect a person’s balance, especially in the initial days after the amputation.
• Difficulty in doing normal daily tasks – Daily chores like cooking, bathing, dressing, writing, washing etc. may become difficult or even impossible in some cases, depending on the type and level of amputation. A person might need to re-learn a lot of things from scratch.
• Stump pain – It is also called residual limb pain. Almost half of the people who undergo an amputation feel pain in the remaining part of their severed limb. This is mainly caused due to the damaged group of nerves at the site of amputation.
• Phantom limb pain – Nearly 80% of amputees are affected by phantom limb pain i.e. sensation of pain in the ‘missing limb’. The brain is said to be the source of pain as the limb for which the excruciating pain is felt is no more part of the person’s body BUT the pain is real.
• Infection – Some people develop an infection after their amputation. This is a serious condition as it can lead to further more surgeries and amputation. Sometimes the infection may lead to the amputation of the remaining portion of the limb. So, it is important to take care that the stump does not get infected.
• Muscle contracture – Contraction of muscles is the natural reaction of the body to cope with the sudden imbalance of muscles in limbs caused due to amputation. This condition is riskier for lower limb amputees. If not taken care muscle contracture can have a devastating effect. This is the reason, physical therapy and stretching exercises are recommended just after the amputation.
• Post-Traumatic Stress Disorder (PTSD) – All the physical pains and hardships may translate to mental stress or depression for an amputee. A person might get flashbacks of the traumatic incident that resulted in the amputation. She may lose her sleep or struggle to keep herself calm. All those mental conditions are grouped under the umbrella term ‘Post Traumatic Stress Disorder’.

Amputation is a tough phase for anyone who has to go through it. But, if a person gets the right professional and personal support, the transition can become much easier. Life can be as beautiful after amputation as it was before it.