Amputation
Of course, amputation is the surgical removal of a part of the body, a limb or part of a limb. There are multiple types of amputations and varied reasons for amputation such as amputation resulting from disease, infections or tumours. This chapter focuses
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AMPUTATION
Amputation is not a condition that you will encounter too often unless you work in a specialised service. It is a condition that shares much in common with other disabilities but also has its unique aspects. Of course, amputation is the surgical removal of a part of the body, a limb or part of a limb. There are multiple types of amputations and varied reasons for amputation such as amputation resulting from disease, infections or tumours. This chapter focuses on amputation as a result of injury. Some brief details are provided about the nature of amputation and two cases are outlined to describe the multiple effects of such trauma on an individual. There is no typical amputee just as there is no typical disability condition. Types of Amputations The three steps involved in an amputation are (a) cutting of soft tissue; (b) treatment of periosteum (vascular connective tissue enveloping the bones except at the surfaces of the join) and cutting of the bone; and (c) stump treatment. 149
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Amputation is performed at the most distal point that will heal successfully. The site of amputation is determined by factors such as sufficient circulation and purposeful value in relation to the use of a prosthesis.
Figure 14.1. Upper and lower extremity amputation levels
The levels of upper and lower amputation are indicated in Figure 14.1. The classifications of each type of amputation are based on the nearest body joint. The specific descriptions of each type are not covered in this chapter. They are fairly self-explanatory and include: (a) forequarter or interscapular; (b) shoulder disarticulation; (c) above the elbow; (d) elbow disarticulation; (e) below elbow; (f) wrist disarticulation; (g) partial hand; (h) transpelvic amputation or hemipelvectomy; (i) hip disarticulation (patients may need to rely on a wheelchair); (j) above the knee (all possible length is preserved); (k) knee disarticulation (most successful with active individuals able to develop precise control of the prosthesis); (l) below the knee; (m) Syme’s amputation (results in a painless, durable extremity 150
AMPUTATION
end that can withstand full weight bearing); (n) transmetatarsal or partial foot (causes minor changes in gait and balance). The most frequent level of amputation is below the knee amputation (transtibial) followed in frequency by above the knee amputation (transfemoral). The aim of surgery is to retain as much of the extremity as possible. Another aim is to retain joints such as knee and elbow. Prosthesis A prosthesis is an artificial limb. It is the name given to a constructed replacement for the missing body part. Fortunately there is a prosthesis for almost any level of amputation. The prosthesis is fitted early for maximum function. Individuals may receive a temporary prosthesis at first and it may take several months before a permanent prosthesis is provided. Generally the lower the level of amputation in low extremity cases then the easier it is to use a prosthesis. There are a range of problems associated with t
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