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Amputation is the removal of a
limb Limb may refer to: Science and technology *Limb (anatomy), an appendage of a human or animal *Limb, a large or main branch of a tree *Limb, in astronomy, the curved edge of the apparent disk of a celestial body, e.g. lunar limb *Limb, in botany, ...
by
trauma Trauma most often refers to: *Major trauma, in physical medicine, severe physical injury caused by an external source *Psychological trauma, a type of damage to the psyche that occurs as a result of a severely distressing event *Traumatic inju ...
,
medical illness A disease is a particular abnormal condition that negatively affects the structure or function (biology), function of all or part of an organism, and that is not immediately due to any external injury. Diseases are often known to be medica ...
, or
surgery Surgery ''cheirourgikē'' (composed of χείρ, "hand", and ἔργον, "work"), via la, chirurgiae, meaning "hand work". is a medical specialty that uses operative manual and instrumental techniques on a person to investigate or treat a pat ...
. As a surgical measure, it is used to control pain or a disease process in the affected limb, such as
malignancy Malignancy () is the tendency of a medical condition to become progressively worse. Malignancy is most familiar as a characterization of cancer. A ''malignant'' tumor contrasts with a non-cancerous ''benign'' tumor in that a malignancy is not s ...
or
gangrene Gangrene is a type of tissue death caused by a lack of blood supply. Symptoms may include a change in skin color to red or black, numbness, swelling, pain, skin breakdown, and coolness. The feet and hands are most commonly affected. If the ga ...
. In some cases, it is carried out on individuals as a preventive surgery for such problems. A special case is that of
congenital amputation Congenital amputation is birth without a limb or limbs, or without a part of a limb or limbs. It is known to be caused by blood clots forming in the fetus while ''in utero'' (vascular insult) and from amniotic band syndrome: fibrous bands of the ...
, a
congenital disorder A birth defect, also known as a congenital disorder, is an abnormal condition that is present at birth regardless of its cause. Birth defects may result in disabilities that may be physical, intellectual, or developmental. The disabilities can ...
, where
fetal A fetus or foetus (; plural fetuses, feti, foetuses, or foeti) is the unborn offspring that develops from an animal embryo. Following embryonic development the fetal stage of development takes place. In human prenatal development, fetal develo ...
limbs have been cut off by constrictive bands. In some countries, amputation is currently used to punish people who commit crimes. Amputation has also been used as a tactic in war and acts of terrorism; it may also occur as a war injury. In some cultures and religions, minor amputations or mutilations are considered a ritual accomplishment. When done by a person, the person executing the amputation is an amputator. The oldest evidence of this practice comes from a skeleton found buried in Liang Tebo cave,
East Kalimantan East Kalimantan (Indonesian: ) is a province of Indonesia. Its territory comprises the eastern portion of Borneo. It had a population of about 3.03 million at the 2010 census (within the current boundary), 3.42 million at the 2015 census, and 3. ...
, Indonesian
Borneo Borneo (; id, Kalimantan) is the third-largest island in the world and the largest in Asia. At the geographic centre of Maritime Southeast Asia, in relation to major Indonesian islands, it is located north of Java, west of Sulawesi, and eas ...
dating back to at least 31,000 years ago, where it was done when the amputee was a young child. In the US, the majority of new amputations occur due to complications of the vascular system (the blood vessels), especially from diabetes. Between 1988 and 1996, there were an average of 133,735 hospital discharges for amputation per year in the US. In 2005, just in the US, there were 1.6 million amputees. In 2013, the US had 2.1 million amputees. Approximately 185,000 amputations occur in the United States each year. In 2009, hospital costs associated with amputation totaled more than $8.3 billion. There will be an estimated 3.6 million people in the US living with limb loss by 2050.


Types


Leg

Lower limb amputations can be divided into two broad categories: minor and major amputations. Minor amputations generally refer to the amputation of digits. Major amputations are commonly below-knee- or above-knee amputations. Common partial foot amputations include the Chopart, Lisfranc, and ray amputations. Common forms of ankle
disarticulation In medical terminology, disarticulation is the separation of two bones at their joint, either traumatically by way of injury or by a surgeon during arthroplasty or amputation. See also * Joint dislocation * Acrotomophilia * Apotemnophilia * Amputa ...
s include Pyrogoff, Boyd, and Syme amputations. A less common major amputation is the
Van Nes rotation Rotationplasty, commonly known as a Van Nes rotation or Borggreve rotation, is a type of autograft wherein a portion of a limb is removed, while the remaining limb below the involved portion is rotated and reattached. This procedure is used when a ...
, or rotationplasty, i.e. the turning around and
reattachment Replantation or reattachment has been defined by the American Academy of Orthopaedic Surgeons as "the surgical reattachment of a body part (such as a finger, hand, or toe) that has been completely cut from the body". Examples would be reattachmen ...
of the foot to allow the ankle joint to take over the function of the knee. Types of amputations include: ; partial foot amputation: amputation of the lower limb distal to the ankle joint ; ankle disarticulation: amputation of the lower limb at the ankle joint ; trans-tibial amputation: amputation of the lower limb between the knee joint and the ankle joint, commonly referred to as a below-knee amputation ; knee disarticulation: amputation of the lower limb at the knee joint ; trans-femoral amputation: amputation of the lower limb between the hip joint and the knee joint, commonly referred to an above-knee amputation ; hip disarticulation: amputation of the lower limb at the hip joint ; trans-pelvic disarticulation: amputation of the whole lower limb together with all or part of the pelvis, also known as a hemipelvectomy or hindquarter amputation


Arm

Types of upper extremity amputations include: * partial hand amputation * wrist disarticulation * trans-radial amputation, commonly referred to as below-elbow or forearm amputation * elbow disarticulation * trans-humeral amputation, commonly referred to as above-elbow amputation * shoulder disarticulation *
forequarter amputation Forequarter amputation is amputation of the arm, scapula and clavicle. It is usually performed as a last resort to remove a cancer, but decreasingly so as limb-sparing operations improve. Surgical technique The rhomboid muscles, trapezius, le ...
A variant of the trans-radial amputation is the
Krukenberg procedure The Krukenberg procedure, also known as the Krukenberg operation, is a surgical technique that converts a forearm stump into a pincer. It was first described in 1917 by the German army surgeon Hermann Krukenberg. It remains in use today for certai ...
in which the radius and ulna are used to create a stump capable of a pincer action.


Other

* Facial amputations include but are not limited to: ** amputation of the ears ** amputation of the nose (
rhinotomy Rhinotomy is mutilation, usually amputation, of the nose. It was a means of judicial punishment throughout the world, particularly for sexual transgressions, but in the case of adultery often applied only to women. Ancient usage The Code of Hamm ...
) ** amputation of the tongue (
glossectomy A glossectomy is the Surgery, surgical removal of all or part of the tongue. It is performed in order to curtail Malignancy, malignant growth such as oral cancer. Often only a portion of the tongue needs to be removed, in which case the procedure ...
). ** amputation of the eyes ( enucleation). ** amputation of the teeth (
dental avulsion Dental avulsion is the complete displacement of a tooth from its socket in alveolar bone owing to trauma. Normally, a tooth is connected to the socket by the periodontal ligament. When a tooth is knocked out, the ligament is torn. Avulsed perman ...
). Removal of teeth, mainly incisors, is or was practiced by some cultures for ritual purposes (for instance in the
Iberomaurusian The Iberomaurusian is a backed bladelet lithic industry found near the coasts of Morocco, Algeria, and Tunisia. It is also known from a single major site in Libya, the Haua Fteah, where the industry is locally known as the Eastern Oranian.The " ...
culture of Neolithic North Africa). * Breasts: ** amputation of the breasts (
mastectomy Mastectomy is the medical term for the surgical removal of one or both breasts, partially or completely. A mastectomy is usually carried out to treat breast cancer. In some cases, women believed to be at high risk of breast cancer have the operat ...
). *
Genitals A sex organ (or reproductive organ) is any part of an animal or plant that is involved in sexual reproduction. The reproductive organs together constitute the reproductive system. In animals, the testis in the male, and the ovary in the female, a ...
: ** amputation of the testicles (
castration Castration is any action, surgical, chemical, or otherwise, by which an individual loses use of the testicles: the male gonad. Surgical castration is bilateral orchiectomy (excision of both testicles), while chemical castration uses pharmaceut ...
). ** amputation of the penis (
penectomy Penectomy is penis removal through surgery, generally for medical or personal reasons. Medical reasons for penectomy Cancer, for example, sometimes necessitates removal of part or all of the penis. The amount of penis removed depends on the se ...
). ** amputation of the
foreskin In male human anatomy, the foreskin, also known as the prepuce, is the double-layered fold of skin, mucosal and muscular tissue at the distal end of the human penis that covers the glans and the urinary meatus. The foreskin is attached to the g ...
(
circumcision Circumcision is a surgical procedure, procedure that removes the foreskin from the human penis. In the most common form of the operation, the foreskin is extended with forceps, then a circumcision device may be placed, after which the foreskin ...
). ** amputation of the clitoris (
clitoridectomy Clitoridectomy or clitorectomy is the surgical removal, reduction, or partial removal of the clitoris. It is rarely used as a therapeutic medical procedure, such as when cancer has developed in or spread to the clitoris. It is often performed on i ...
).
Hemicorporectomy Hemicorporectomy is a radical surgery in which the body below the waist is amputated, transecting the lumbar spine. This removes the legs, the genitalia (internal and external), urinary system, pelvic bones, anus, and rectum. It is an extremel ...
, or amputation at the waist, and
decapitation Decapitation or beheading is the total separation of the head from the body. Such an injury is invariably fatal to humans and most other animals, since it deprives the brain of oxygenated blood, while all other organs are deprived of the i ...
, or amputation at the neck, are the most radical amputations.
Genital modification and mutilation The terms genital modification and genital mutilation can refer to permanent or temporary changes to human sex organs. Some forms of genital alteration are performed on adults with their informed consent at their own behest, usually for aesthetic ...
may involve amputating tissue, although not necessarily as a result of injury or disease.


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 or her own limb. The most notable case of this is
Aron Ralston Aron Lee Ralston (born October 27, 1975) is an American mountaineer, mechanical engineer, and motivational speaker, known for surviving a canyoneering accident by cutting off part of his right arm. On April 26, 2003, during a solo descent of Bl ...
, a hiker who amputated his own right forearm after it was pinned by a boulder in a hiking accident and he was unable to free himself for over five days.
Body integrity identity disorder Body integrity dysphoria (BID, also referred to as body integrity identity disorder, amputee identity disorder and xenomelia, formerly called apotemnophilia) is a mental disorder characterized by a desire to have a sensory or physical disabili ...
is a psychological condition in which an individual feels compelled to remove one or more of their body parts, usually a limb. In some cases, that individual may take drastic measures to remove the offending appendages, either by causing irreparable damage to the limb so that medical intervention cannot save the limb, or by causing the limb to be severed.


Causes


Circulatory disorders

*
Diabetic Diabetes, also known as diabetes mellitus, is a group of metabolic disorders characterized by a high blood sugar level (hyperglycemia) over a prolonged period of time. Symptoms often include frequent urination, increased thirst and increased app ...
vasculopathy *
Sepsis Sepsis, formerly known as septicemia (septicaemia in British English) or blood poisoning, is a life-threatening condition that arises when the body's response to infection causes injury to its own tissues and organs. This initial stage is follo ...
with peripheral necrosis *
Peripheral artery disease Peripheral artery disease (PAD) is an abnormal narrowing of arteries other than those that supply the heart or brain. When narrowing occurs in the heart, it is called coronary artery disease, and in the brain, it is called cerebrovascular diseas ...
which can lead to
gangrene Gangrene is a type of tissue death caused by a lack of blood supply. Symptoms may include a change in skin color to red or black, numbness, swelling, pain, skin breakdown, and coolness. The feet and hands are most commonly affected. If the ga ...
* A severe
deep vein thrombosis Deep vein thrombosis (DVT) is a type of venous thrombosis involving the formation of a blood clot in a deep vein, most commonly in the legs or pelvis. A minority of DVTs occur in the arms. Symptoms can include pain, swelling, redness, and enla ...
(
phlegmasia cerulea dolens Phlegmasia cerulea dolens (PCD) (literally: 'painful blue inflammation'), not to be confused with preceding phlegmasia alba dolens, is an uncommon severe form of lower extremity deep venous thrombosis (DVT) that obstructs blood outflow from a vei ...
) can cause
compartment syndrome Compartment syndrome is a condition in which increased pressure within one of the body's anatomical compartments results in insufficient blood supply to tissue within that space. There are two main types: acute and chronic. Compartments of the ...
and gangrene


Neoplasm

* Cancerous bone or soft tissue tumors (e.g.
osteosarcoma An osteosarcoma (OS) or osteogenic sarcoma (OGS) (or simply bone cancer) is a cancerous tumor in a bone. Specifically, it is an aggressive malignant neoplasm that arises from primitive transformed cells of mesenchymal origin (and thus a sarcoma) a ...
,
chondrosarcoma Chondrosarcoma is a bone sarcoma, a primary cancer composed of cells derived from transformed cells that produce cartilage. A chondrosarcoma is a member of a category of tumors of bone and soft tissue known as sarcomas. About 30% of bone sarcomas ...
,
fibrosarcoma Fibrosarcoma (fibroblastic sarcoma) is a malignant mesenchymal tumour derived from fibrous connective tissue and characterized by the presence of immature proliferating fibroblasts or undifferentiated anaplastic spindle cells in a storiform patte ...
,
epithelioid sarcoma Epithelioid sarcoma is a rare soft tissue sarcoma arising from mesenchymal tissue and characterized by epithelioid-like features. It accounts for less than 1% of all soft tissue sarcomas. It was first clearly characterized by F.M. Enzinger in 197 ...
,
Ewing's sarcoma Ewing sarcoma is a type of cancer that forms in bone or soft tissue. Symptoms may include swelling and pain at the site of the tumor, fever, and a bone fracture. The most common areas where it begins are the legs, pelvis, and chest wall. In about ...
,
synovial sarcoma A synovial sarcoma (also known as malignant synovioma) is a rare form of cancer which occurs primarily in the extremities of the arms or legs, often in proximity to joint capsules and tendon sheaths. It is a type of soft-tissue sarcoma. The name " ...
,
sacrococcygeal teratoma Sacrococcygeal teratoma (SCT) is a type of tumor known as a teratoma that develops at the base of the coccyx (tailbone) and is thought to be primarily derived from remnants of the primitive streak. Sacrococcygeal teratomas are benign 75% of the ti ...
,
liposarcoma Liposarcomas are the most common subtype of soft tissue sarcomas, accounting for at least 20% of all sarcomas in adults. Soft tissue sarcomas are rare neoplasms with over 150 different histological subtypes or forms. Liposarcomas arise from the pr ...
),
melanoma Melanoma, also redundantly known as malignant melanoma, is a type of skin cancer that develops from the pigment-producing cells known as melanocytes. Melanomas typically occur in the skin, but may rarely occur in the mouth, intestines, or eye ( ...


Trauma

* Severe limb
injuries An injury is any physiological damage to living tissue caused by immediate physical stress. An injury can occur intentionally or unintentionally and may be caused by blunt trauma, penetrating trauma, burning, toxic exposure, asphyxiation, or ...
in which the limb cannot be saved or efforts to save the limb fail. * Traumatic amputation (an unexpected amputation that occurs at the scene of an accident, where the limb is partially or entirely severed as a direct result of the accident, for example, a finger that is severed from the blade of a table saw) * Amputation in utero (
Amniotic band Constriction ring syndrome (CRS) is a congenital disorder with unknown cause. Because of the unknown cause there are many different, and sometimes incorrect names. It is a malformation due to intrauterine bands or rings that give deep grooves in, ...
)


Congenital anomalies

* Deformities of digits and/or limbs (e.g.,
proximal femoral focal deficiency Proximal femoral focal deficiency (PFFD), also known as Congenital Femoral Deficiency (CFD), is a rare, non-hereditary birth defect that affects the pelvis, particularly the hip bone, and the proximal femur. The disorder may affect one side or ...
,
Fibular hemimelia Fibular hemimelia or longitudinal fibular deficiency is "the congenital absence of the fibula and it is the most common congenital absence of long bone of the extremities." It is the shortening of the fibula at birth, or the complete lack thereof ...
) * Extra digits and/or limbs (e.g.,
polydactyly Polydactyly or polydactylism (), also known as hyperdactyly, is an anomaly in humans and animals resulting in supernumerary fingers and/or toes. Polydactyly is the opposite of oligodactyly (fewer fingers or toes). Signs and symptoms In humans ...
)


Infection

* Bone infection (
osteomyelitis Osteomyelitis (OM) is an infection of bone. Symptoms may include pain in a specific bone with overlying redness, fever, and weakness. The long bones of the arms and legs are most commonly involved in children e.g. the femur and humerus, while the ...
) and/or diabetic foot infections *
Gangrene Gangrene is a type of tissue death caused by a lack of blood supply. Symptoms may include a change in skin color to red or black, numbness, swelling, pain, skin breakdown, and coolness. The feet and hands are most commonly affected. If the ga ...
*
Trench foot Trench foot is a type of foot damage due to moisture. Initial symptoms often include tingling or itching which can progress to numbness. The feet may become red or bluish in color. As the condition worsens the feet can start to swell and smel ...
*
Necrosis Necrosis () is a form of cell injury which results in the premature death of cells in living tissue by autolysis. Necrosis is caused by factors external to the cell or tissue, such as infection, or trauma which result in the unregulated dige ...
*
Meningococcal meningitis Meningococcal disease describes infections caused by the bacterium ''Neisseria meningitidis'' (also termed meningococcus). It has a high mortality rate if untreated but is vaccine-preventable. While best known as a cause of meningitis, it can a ...
*
Streptococcus ''Streptococcus'' is a genus of gram-positive ' (plural ) or spherical bacteria that belongs to the family Streptococcaceae, within the order Lactobacillales (lactic acid bacteria), in the phylum Bacillota. Cell division in streptococci occurs ...
*
Vibrio vulnificus ''Vibrio vulnificus'' is a species of Gram-negative, motile, curved rod-shaped (bacillus), pathogenic bacteria of the genus ''Vibrio''. Present in marine environments such as estuaries, brackish ponds, or coastal areas, ''V. vulnificus'' is relat ...
*
Necrotizing fasciitis Necrotizing fasciitis (NF), also known as flesh-eating disease, is a bacterial infection that results in the death of parts of the body's soft tissue. It is a severe disease of sudden onset that spreads rapidly. Symptoms usually include red or p ...
*
Gas gangrene Gas gangrene (also known as clostridial myonecrosis and myonecrosis) is a bacterial infection that produces tissue gas in gangrene. This deadly form of gangrene usually is caused by ''Clostridium perfringens'' bacteria. About 1,000 cases of gas g ...
*
Legionella ''Legionella'' is a genus of pathogenic gram-negative bacteria that includes the species '' L. pneumophila'', causing legionellosis (all illnesses caused by ''Legionella'') including a pneumonia-type illness called Legionnaires' disease and a mi ...
*
Influenza A Virus ''Influenza A virus'' (''IAV'') causes influenza in birds and some mammals, and is the only species of the genus ''Alphainfluenzavirus'' of the virus family ''Orthomyxoviridae''. Strain (biology)#Microbiology or virology, Strains of all subtypes ...
* Animal bites *
Sepsis Sepsis, formerly known as septicemia (septicaemia in British English) or blood poisoning, is a life-threatening condition that arises when the body's response to infection causes injury to its own tissues and organs. This initial stage is follo ...
*
Bubonic plague Bubonic plague is one of three types of plague caused by the plague bacterium (''Yersinia pestis''). One to seven days after exposure to the bacteria, flu-like symptoms develop. These symptoms include fever, headaches, and vomiting, as well a ...


Frostbite

Frostbite Frostbite is a skin injury that occurs when exposed to extreme low temperatures, causing the freezing of the skin or other tissues, commonly affecting the fingers, toes, nose, ears, cheeks and chin areas. Most often, frostbite occurs in the han ...
is a cold-related injury occurring when an area (typically a limb or other extremity) is exposed to extreme low temperatures, causing the freezing of the skin or other tissues. Its
pathophysiology Pathophysiology ( physiopathology) – a convergence of pathology with physiology – is the study of the disordered physiological processes that cause, result from, or are otherwise associated with a disease or injury. Pathology is the ...
involves the formation of ice crystals upon freezing and
blood clot A thrombus (plural thrombi), colloquially called a blood clot, is the final product of the blood coagulation step in hemostasis. There are two components to a thrombus: aggregated platelets and red blood cells that form a plug, and a mesh of c ...
s upon thawing, leading to
cell damage Cell damage (also known as cell injury) is a variety of changes of stress that a cell suffers due to external as well as internal environmental changes. Amongst other causes, this can be due to physical, chemical, infectious, biological, nutritiona ...
and
cell death Cell death is the event of a biological cell ceasing to carry out its functions. This may be the result of the natural process of old cells dying and being replaced by new ones, as in programmed cell death, or may result from factors such as dis ...
. Treatment of severe frostbite may require surgical amputation of the affected tissue or limb; if there is deep injury
autoamputation Autoamputation is the spontaneous detachment (amputation) of an appendage or organ from the body. This is not to be confused with self-amputation. It is usually due to destruction of the blood vessels feeding an extremity such as the finger tips. O ...
may occur.


Athletic performance

Sometimes professional
athletes An athlete (also sportsman or sportswoman) is a person who competes in one or more sports that involve physical strength, speed, or endurance. Athletes may be professionals or amateurs. Most professional athletes have particularly well-develo ...
may choose to have a non-essential digit amputated to relieve chronic pain and impaired performance. * Australian Rules footballer
Daniel Chick Daniel Patrick Chick (born 10 February 1976) is a former Australian rules footballer who played for Hawthorn and the West Coast Eagles in the Australian Football League. Chick is also well known for having a finger amputated in 2002 so he cou ...
elected to have his left
ring finger The ring finger, third finger, fourth finger, leech finger, or annulary is the fourth digit of the human hand, located between the middle finger and the little finger. Sometimes the term ring finger only refers to the fourth digit of a left-han ...
amputated as chronic pain and injury was limiting his performance. *
Rugby union Rugby union, commonly known simply as rugby, is a close-contact team sport that originated at Rugby School in the first half of the 19th century. One of the two codes of rugby football, it is based on running with the ball in hand. In its m ...
player
Jone Tawake Jone Tawake (born 17 April 1982), is a Fijian born rugby union player. He currently competes in the Top 14 for Toulon. He previously played in the Super 14 competition for the ACT Brumbies and the New South Wales Waratahs. His position of choice i ...
also had a finger removed. *
National Football League The National Football League (NFL) is a professional American football league that consists of 32 teams, divided equally between the American Football Conference (AFC) and the National Football Conference (NFC). The NFL is one of the ...
safety Safety is the state of being "safe", the condition of being protected from harm or other danger. Safety can also refer to risk management, the control of recognized hazards in order to achieve an acceptable level of risk. Meanings There are ...
Ronnie Lott Ronald Mandel Lott (born May 8, 1959) is an American former professional football player who was a cornerback and safety in the National Football League (NFL) for 14 seasons during the 1980s and 1990s. Lott played college football for the Univ ...
had the tip of his little finger removed after it was damaged in the
1985 NFL season The 1985 NFL season was the 66th regular season of the National Football League. The season ended with Super Bowl XX when the Chicago Bears defeated the New England Patriots 46–10 at the Louisiana Superdome. The Bears became the second team ...
.


Criminal penalty

* According to Quran 5:38, the punishment for stealing is the amputation of the hand. Under
Sharia law Sharia (; ar, شريعة, sharīʿa ) is a body of religious law that forms a part of the Islamic tradition. It is derived from the Five Pillars of Islam, religious precepts of Islam and is based on the Islamic holy books, sacred scriptures o ...
, after repeated offense, the foot may also be cut off. This is still in practice today in countries like
Brunei Brunei ( , ), formally Brunei Darussalam ( ms, Negara Brunei Darussalam, Jawi alphabet, Jawi: , ), is a country located on the north coast of the island of Borneo in Southeast Asia. Apart from its South China Sea coast, it is completely sur ...
, the
United Arab Emirates The United Arab Emirates (UAE; ar, اَلْإِمَارَات الْعَرَبِيَة الْمُتَحِدَة ), or simply the Emirates ( ar, الِْإمَارَات ), is a country in Western Asia (The Middle East). It is located at th ...
,
Iran Iran, officially the Islamic Republic of Iran, and also called Persia, is a country located in Western Asia. It is bordered by Iraq and Turkey to the west, by Azerbaijan and Armenia to the northwest, by the Caspian Sea and Turkmeni ...
,
Saudi Arabia Saudi Arabia, officially the Kingdom of Saudi Arabia (KSA), is a country in Western Asia. It covers the bulk of the Arabian Peninsula, and has a land area of about , making it the fifth-largest country in Asia, the second-largest in the A ...
,
Yemen Yemen (; ar, ٱلْيَمَن, al-Yaman), officially the Republic of Yemen,, ) is a country in Western Asia. It is situated on the southern end of the Arabian Peninsula, and borders Saudi Arabia to the Saudi Arabia–Yemen border, north and ...
, and 11 of the 36 states within
Nigeria Nigeria ( ), , ig, Naìjíríyà, yo, Nàìjíríà, pcm, Naijá , ff, Naajeeriya, kcg, Naijeriya officially the Federal Republic of Nigeria, is a country in West Africa. It is situated between the Sahel to the north and the Gulf o ...
. * In 1779,
Thomas Jefferson Thomas Jefferson (April 13, 1743 – July 4, 1826) was an American statesman, diplomat, lawyer, architect, philosopher, and Founding Fathers of the United States, Founding Father who served as the third president of the United States from 18 ...
proposed a bill to the
Virginia Assembly The Virginia General Assembly is the legislative body of the Commonwealth of Virginia, the oldest continuous law-making body in the Western Hemisphere, the first elected legislative assembly in the New World, and was established on July 30, 1619 ...
that ostensibly would have replaced
capital punishment Capital punishment, also known as the death penalty, is the state-sanctioned practice of deliberately killing a person as a punishment for an actual or supposed crime, usually following an authorized, rule-governed process to conclude that t ...
with other penalties, including amputation, for certain crimes, although not all were really punishable by death at the time. For the crimes of rape, sodomy, and polygamy (the latter removed from a later version), the punishment was to be
castration Castration is any action, surgical, chemical, or otherwise, by which an individual loses use of the testicles: the male gonad. Surgical castration is bilateral orchiectomy (excision of both testicles), while chemical castration uses pharmaceut ...
for men or
rhinotomy Rhinotomy is mutilation, usually amputation, of the nose. It was a means of judicial punishment throughout the world, particularly for sexual transgressions, but in the case of adultery often applied only to women. Ancient usage The Code of Hamm ...
for women. For intentional maiming, the bill specified literal
eye for an eye "An eye for an eye" ( hbo, עַיִן תַּחַת עַיִן, ) is a commandment found in the Book of Exodus 21:23–27 expressing the principle of reciprocal justice measure for measure. The principle exists also in Babylonian law. In Roman c ...
retribution. The bill never passed, due to the combination of its barbarity in some parts and perceived leniency in others. * From the 16th century, English law provided for cutting off a hand as punishment for striking someone inside a courtroom. Thomas Jefferson's punishments revision bill also intended to repeal this. * As of 2021, this form of punishment is controversial, as most modern cultures consider it to be morally abhorrent, as it has the effect of permanently disabling a person and constitutes torture. It is thus seen as grossly disproportionate for crimes less than those such as murder.


Surgery


Method

The first step is ligating the supplying
artery An artery (plural arteries) () is a blood vessel in humans and most animals that takes blood away from the heart to one or more parts of the body (tissues, lungs, brain etc.). Most arteries carry oxygenated blood; the two exceptions are the pul ...
and
vein Veins are blood vessels in humans and most other animals that carry blood towards the heart. Most veins carry deoxygenated blood from the tissues back to the heart; exceptions are the pulmonary and umbilical veins, both of which carry oxygenated b ...
, to prevent
hemorrhage Bleeding, hemorrhage, haemorrhage or blood loss, is blood escaping from the circulatory system from damaged blood vessels. Bleeding can occur internally, or externally either through a natural opening such as the mouth, nose, ear, urethra, vag ...
(bleeding). The muscles are transected, and finally, the
bone A bone is a Stiffness, rigid Organ (biology), organ that constitutes part of the skeleton in most vertebrate animals. Bones protect the various other organs of the body, produce red blood cell, red and white blood cells, store minerals, provid ...
is sawed through with an
oscillating saw A multitool or oscillating tool is a power tool that oscillates (rather than rotating or reciprocating), powered by battery or mains. The name "multi-tool" is a reference to the many functions that this tool can perform with the range of attac ...
. Sharp and rough edges of bones are filed, skin and muscle flaps are then transposed over the stump, occasionally with the insertion of elements to attach a
prosthesis In medicine, a prosthesis (plural: prostheses; from grc, πρόσθεσις, prósthesis, addition, application, attachment), or a prosthetic implant, is an artificial device that replaces a missing body part, which may be lost through trau ...
. Distal stabilisation of muscles is recommended. This allows effective muscle contraction which reduces atrophy, allows functional use of the stump and maintains soft tissue coverage of the remnant bone. The preferred stabilisation technique is myodesis where the muscle is attached to the bone or its periosteum. In joint disarticulation amputations tenodesis may be used where the muscle tendon is attached to the bone. Muscles should be attached under similar tension to normal physiological conditions. An experimental technique known as the "Ewing amputation" aims to improve post-amputation
proprioception Proprioception ( ), also referred to as kinaesthesia (or kinesthesia), is the sense of self-movement, force, and body position. It is sometimes described as the "sixth sense". Proprioception is mediated by proprioceptors, mechanosensory neurons ...
. In 1920,  Dr. Janos Ertl, Sr. of
Hungary Hungary ( hu, Magyarország ) is a landlocked country in Central Europe. Spanning of the Carpathian Basin, it is bordered by Slovakia to the north, Ukraine to the northeast, Romania to the east and southeast, Serbia to the south, Croatia a ...
, developed the Ertl procedure in order to return a high number of amputees to the work force. The Ertl technique, an osteomyoplastic procedure for transtibial amputation, can be used to create a highly functional residual limb. Creation of a tibiofibular bone bridge provides a stable, broad tibiofibular articulation that may be capable of some distal weight bearing. Several different modified techniques and fibular bridge fixation methods have been used; however, no current evidence exists regarding comparison of the different techniques.


Post-operative management

A 2019
Cochrane Cochrane may refer to: Places Australia *Cochrane railway station, Sydney, a railway station on the closed Ropes Creek railway line Canada * Cochrane, Alberta * Cochrane Lake, Alberta * Cochrane District, Ontario ** Cochrane, Ontario, a town wit ...
systematic review A systematic review is a Literature review, scholarly synthesis of the evidence on a clearly presented topic using critical methods to identify, define and assess research on the topic. A systematic review extracts and interprets data from publ ...
aimed to determine whether rigid dressings were more effective than soft dressings in helping wounds heal following transtibial (below the knee) amputations. Due to the limited and very low certainty evidence available, the authors concluded that it was uncertain what the benefits and harms were for each dressing type. They recommended that clinicians consider the pros and cons of each dressing type on a case-by-case basis e.g. rigid dressings may potentially benefit patients who have a high risk of falls and soft dressings may potentially benefit patients who have poor skin integrity. A 2017 review found that the use of rigid removable dressings (RRD's) in trans-tibial amputations, rather than soft bandaging, improved healing time, reduced edema, prevented knee flexion contractures and reduced complications, including further amputation, from external trauma such as falls onto the stump. Post-operative management, in addition to wound healing, should consider maintenance of limb strength, joint range, edema management, preservation of the intact limb (if applicable) and stump desensitization.


Trauma

Traumatic amputation is the partial or total avulsion of a part of a body during a serious accident, like traffic, labor, or combat. Traumatic amputation of a human limb, either partial or total, creates the immediate danger of death from blood loss. Orthopedic surgeons often assess the severity of different injuries using the Mangled Extremity Severity Score. Given different clinical and situational factors, they can predict the likelihood of amputation. This is especially useful for emergency physicians to quickly evaluate patients and decide on consultations.


Causes

Traumatic amputation is uncommon in humans (1 per 20,804 population per year). Loss of limb usually happens immediately during the accident, but sometimes a few days later after medical complications. Statistically, the most common causes of traumatic amputations are: * Vehicle accidents (cars, motorcycles, bicycles, trains, etc.) * Labor accidents (equipment, instruments, cylinders, chainsaws, press machines, meat machines, wood machines, etc.) * Agricultural accidents, with machines and mower equipment * Electric shock hazards * Firearms, bladed weapons, explosives * Violent rupture of ship rope or industry wire rope * Ring traction (ring amputation, de-gloving injuries) * Building doors and car doors * Animal attacks * Gas cylinder explosions * Other rare accidents


Treatment

The development of the science of
microsurgery Microsurgery is a general term for surgery requiring an operating microscope. The most obvious developments have been procedures developed to allow anastomosis of successively smaller blood vessels and nerves (typically 1 mm in diameter) which ...
over the last 40 years has provided several treatment options for a traumatic amputation, depending on the patient's specific trauma and clinical situation: * 1st choice: Surgical amputation - break - prosthesis * 2nd choice: Surgical amputation - transplantation of other tissue - plastic reconstruction. * 3rd choice:
Replantation Replantation or reattachment has been defined by the American Academy of Orthopaedic Surgeons as "the surgical reattachment of a body part (such as a finger, hand, or toe) that has been completely cut from the body". Examples would be reattachme ...
- reconnection - revascularisation of amputated limb, by microscope (after 1969) * 4th choice: Transplantation of cadaveric hand (after 2000)


Epidemiology

* In the United States in 1999, there were 14,420 non-fatal traumatic amputations according to the
American Statistical Association The American Statistical Association (ASA) is the main professional organization for statisticians and related professionals in the United States. It was founded in Boston, Massachusetts on November 27, 1839, and is the second oldest continuousl ...
. Of these, 4,435 occurred as a result of traffic and transportation accidents and 9,985 were due to labor accidents. Of all traumatic amputations, the distribution percentage is 30.75% for traffic accidents and 69.24% for labor accidents. * The population of the United States in 1999 was about 300,000,000, so the conclusion is that there is one amputation per 20,804 persons per year. In the group of labor amputations, 53% occurred in laborers and technicians, 30% in production and service workers, 16% in silviculture and fishery workers. * A study found that in 2010, 22.8% of patients undergoing amputation of a lower extremity in the United States were readmitted to the hospital within 30 days.


Prevention

Methods in preventing amputation,
limb-sparing techniques Limb-sparing techniques, also known as limb-saving or limb-salvage techniques, are performed in order to preserve the look and function of limbs. Limb-sparing techniques are used to preserve limbs affected by trauma, arthritis, cancers such as high- ...
, depend on the problems that might cause amputations to be necessary. Chronic infections, often caused by diabetes or
decubitus ulcers Pressure ulcers, also known as pressure sores, bed sores or pressure injuries, are localised damage to the skin and/or underlying tissue that usually occur over a bony prominence as a result of usually long-term pressure, or pressure in combi ...
in bedridden patients, are common causes of infections that lead to gangrene, which would then necessitate amputation. There are two key challenges: first, many patients have impaired circulation in their extremities, and second, they have difficulty curing infections in limbs with poor blood circulation. Crush injuries where there is extensive tissue damage and poor circulation also benefit from
hyperbaric oxygen therapy Hyperbaric medicine is medical treatment in which an ambient pressure greater than sea level atmospheric pressure is a necessary component. The treatment comprises hyperbaric oxygen therapy (HBOT), the medical use of oxygen at an ambient pressure ...
(HBOT). The high level of oxygenation and revascularization speed up recovery times and prevent infections. A study found that the patented method called Circulator Boot achieved significant results in prevention of amputation in patients with diabetes and arteriosclerosis. Another study found it also effective for healing limb ulcers caused by peripheral vascular disease. The boot checks the heart rhythm and compresses the limb between heartbeats; the compression helps cure the wounds in the walls of veins and arteries, and helps to push the blood back to the heart. For victims of trauma, advances in
microsurgery Microsurgery is a general term for surgery requiring an operating microscope. The most obvious developments have been procedures developed to allow anastomosis of successively smaller blood vessels and nerves (typically 1 mm in diameter) which ...
in the 1970s have made replantations of severed body parts possible. The establishment of laws, rules, and guidelines, and employment of modern equipment help protect people from traumatic amputations.


Prognosis

The individual may experience psychological trauma and emotional discomfort. The stump will remain an area of reduced mechanical stability. Limb loss can present significant or even drastic practical limitations. A large proportion of amputees (50–80%) experience the phenomenon of
phantom limb A phantom limb is the sensation that an amputated or missing limb is still attached. Approximately 80 to 100% of individuals with an amputation experience sensations in their amputated limb. However, only a small percentage will experience painf ...
s; they feel body parts that are no longer there. These limbs can itch, ache, burn, feel tense, dry or wet, locked in or trapped or they can 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 The phantom eye syndrome (PES) is a phantom pain in the eye and visual hallucinations after the removal of an eye ( enucleation, evisceration). Symptoms Many patients experience one or more phantom phenomena after the removal of the eye: *Pha ...
). 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, expands into the surrounding brain, (''
Phantoms in the Brain ''Phantoms in the Brain: Probing the Mysteries of the Human Mind'' (also published as ''Phantoms in the Brain: Human Nature and the Architecture of the Mind'') is a 1998 popular science book by neuroscientist V.S. Ramachandran and ''New York Time ...
'':
V.S. Ramachandran Vilayanur Subramanian Ramachandran (born 10 August 1951) is an Indian-American neuroscientist. He is known for his wide-ranging experiments and theories in behavioral neurology, including the invention of the mirror box. Ramachandran is a disti ...
and
Sandra Blakeslee Sandra Blakeslee (born 1943) is an American science correspondent of over four decades for ''The New York Times'' and science writer, specializing in neuroscience. Together with neuroscientist V. S. Ramachandran, she authored the 1998 popular sci ...
) such that an individual who has had an arm amputated will experience unexplained pressure or movement on his face or head. In many cases, the phantom limb aids in adaptation to a prosthesis, as it permits the person to experience
proprioception Proprioception ( ), also referred to as kinaesthesia (or kinesthesia), is the sense of self-movement, force, and body position. It is sometimes described as the "sixth sense". Proprioception is mediated by proprioceptors, mechanosensory neurons ...
of the prosthetic limb. To support improved resistance or usability, comfort or healing, some type of
stump sock Stump socks are tubular medical or clothing accessories with a blind end that are fashioned similar to socks, usually without a heel. They are worn on amputation stumps for a number of reasons. As stump socks are typically worn on body parts that ...
s may be worn instead of or as part of wearing a prosthesis. Another side effect can be
heterotopic ossification Heterotopic ossification (HO) is the process by which bone tissue forms outside of the skeleton in muscles and soft tissue. Symptoms In traumatic heterotopic ossification (traumatic myositis ossificans), the patient may complain of a warm, tend ...
, 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 device An improvised explosive device (IED) is a bomb constructed and deployed in ways other than in conventional military action. It may be constructed of conventional military explosives, such as an artillery shell, attached to a detonating mechan ...
s in the
Iraq War {{Infobox military conflict , conflict = Iraq War {{Nobold, {{lang, ar, حرب العراق (Arabic) {{Nobold, {{lang, ku, شەڕی عێراق (Kurdish languages, Kurdish) , partof = the Iraq conflict (2003–present), I ...
. Due to technological advances in prosthetics, many amputees live active lives with little restriction. Organizations such as the
Challenged Athletes Foundation The Challenged Athletes Foundation (CAF), established in 1997, assists, supports, and provides opportunity to people with physical challenges, so that they can lead active lifestyles and compete in athletic events. It is founded in the belief th ...
have been developed to give amputees the opportunity to be involved in athletics and
adaptive sports Parasports are sports played by people with a disability, including physical disability, physical and intellectual disabilities. Some parasports are forms of adapted physical activities from existing able-bodied sports, while others have been spec ...
such as
amputee soccer Amputee football is a disabled sport played with seven players on each team (six outfield players and one goalkeeper). Outfield players have lower extremity amputations, and goalkeepers have an upper extremity amputation. Outfield players use lof ...
. Nearly half of the individuals who have an amputation due to vascular disease will die within 5 years, usually secondary to the extensive co-morbidities rather than due to direct consequences of amputation. This is higher than the five year mortality rates for breast cancer, colon cancer, and prostate cancer. Of persons with diabetes who have a lower extremity amputation, up to 55% will require amputation of the second leg within two to three years.


Etymology

The word amputation is borrowed from Latin ''amputātus,'' past participle of ''amputāre'' "to prune back (a plant), prune away, remove by cutting (unwanted parts or features), cut off (a branch, limb, body part)," from ''am-,'' assimilated variant of ''amb-'' "about, around" + ''putāre'' "to prune, make clean or tidy, scour (wool)". The English word "Poes" was first applied to surgery in the 17th century, possibly first in Peter Lowe's ''A discourse of the Whole Art of Chirurgerie'' (published in either 1597 or 1612); his work was derived from 16th-century French texts and early English writers also used the words "extirpation" (16th-century French texts tended to use ''extirper''), "
disarticulation In medical terminology, disarticulation is the separation of two bones at their joint, either traumatically by way of injury or by a surgeon during arthroplasty or amputation. See also * Joint dislocation * Acrotomophilia * Apotemnophilia * Amputa ...
", and "
dismemberment Dismemberment is the act of cutting, ripping, tearing, pulling, wrenching or otherwise disconnecting the limbs from a living or dead being. It has been practiced upon human beings as a form of capital punishment, especially in connection with ...
" (from the Old French ''desmembrer'' and a more common term before the 17th century for limb loss or removal), or simply "cutting", but by the end of the 17th century "amputation" had come to dominate as the accepted medical term.


Notable cases

*
Patch Adams Hunter Doherty "Patch" Adams (born May 28, 1945) is an American physician, comedian, social activist, clown, and author. He founded the Gesundheit! Institute in 1971. Each year he also organizes volunteers from around the world to travel to var ...
* Rick Allen *
Douglas Bader Group Captain Sir Douglas Robert Steuart Bader, (; 21 February 1910 – 5 September 1982) was a Royal Air Force flying ace during the Second World War. He was credited with 22 aerial victories, four shared victories, six probables, one shared ...
* Götz of the Iron Hand *
Carl Brashear Carl Maxie Brashear (January 19, 1931 – July 25, 2006) was a United States Navy sailor. He was a master diver, rising to the position in 1970, despite having his left leg amputated in 1966. The film '' Men of Honor'' was based on his life. E ...
*
Lisa Bufano Lisa Bufano (October 20, 1972 – October 3, 2013) was an American interdisciplinary performance artist whose work incorporated elements of doll-making, fabric work, animation, and dance. Early life Born to Louis A. Bufano and Elizabeth "Betty" ...
*
Tammy Duckworth Ladda Tammy Duckworth (born March 12, 1968) is an American politician and retired Army National Guard lieutenant colonel serving as the junior United States senator from Illinois since 2017. A member of the Democratic Party, she represented Ill ...
*
Terry Fox Terrance Stanley Fox (July 28, 1958 June 28, 1981) was a Canadian athlete, humanitarian, and cancer research activist. In 1980, with one leg having been amputated due to cancer, he embarked on an east-to-west cross-Canada run to raise money ...
*
Pete Gray Pete or Petes or ''variation'', may refer to: People * Pete (given name) * Pete (nickname) * Pete (surname) Fictional characters * Pete (Disney), a cartoon character in the ''Mickey Mouse'' universe * Pete the Pup (a.k.a. 'Petey'), a character ...
*
Shaquem Griffin Shaquem Alphonso Griffin (born July 20, 1995) is a former American football linebacker. He is the twin brother of Jacksonville Jaguars cornerback Shaquill Griffin, and both brothers played college football at UCF. When Griffin was 4 years old, ...
*
Robert David Hall Robert David Hall (born November 9, 1947) is an American actor, best known for his role as coroner Dr. Albert Robbins, M.D. on the television show ''CSI: Crime Scene Investigation''. Early life Born in East Orange, New Jersey, Hall attended ...
*
Bethany Hamilton Bethany Meilani Hamilton (born February 8, 1990) is an American professional surfer and writer who survived a 2003 shark attack in which her left arm was bitten off and who ultimately returned to professional surfing. She wrote about her exper ...
*
Hugh Herr Hugh Herr (born October 25, 1964) is an American rock climber, engineer, and biophysicist. Early life The youngest of five siblings of a Mennonite family from Lancaster, Pennsylvania, Hugh Herr was a prodigy rock climber: by age 8, he had scale ...
*
Frida Kahlo Magdalena Carmen Frida Kahlo y Calderón (; 6 July 1907 – 13 July 1954) was a Mexican painter known for her many portraits, self-portraits, and works inspired by the nature and artifacts of Mexico. Inspired by the country's popular culture, ...
*
Aimee Mullins Aimee Mullins is an American athlete, actress, and public speaker. She was born with a medical condition that resulted in the amputation of both of her legs beneath the knee. She is the first amputee to compete against able-bodied athletes in Na ...
*
Oscar Pistorius Oscar Leonard Carl Pistorius (; ; born 22 November 1986) is a South African convicted murderer and former professional sprinter. Both of his feet were amputated when he was 11 months old owing to a congenital defect; he was born missing the o ...
*
Amy Purdy Amy Michelle Purdy (born November 7, 1979) is an American actress, model, para-snowboarder, motivational speaker, clothing designer and author. Purdy is a 2014 Paralympic bronze medalist, 2018 Paralympics silver medalist, and one of the top ...
*
Aron Ralston Aron Lee Ralston (born October 27, 1975) is an American mountaineer, mechanical engineer, and motivational speaker, known for surviving a canyoneering accident by cutting off part of his right arm. On April 26, 2003, during a solo descent of Bl ...
*
Hans-Ulrich Rudel Hans-Ulrich Rudel (2 July 1916 – 18 December 1982) was a German ground-attack pilot during World War II and a post-war neo-Nazi activist. The most decorated German pilot of the war and the only recipient of the Knight's Cross with G ...
*
Alex Zanardi Alessandro "Alex" Zanardi (; born 23 October 1966) is an Italian professional racing driver and paracyclist. He won the CART championship in 1997 and 1998, and took 15 wins in the series. He also raced in Formula One from 1991 to 1994 and aga ...
*
Ronnie Lott Ronald Mandel Lott (born May 8, 1959) is an American former professional football player who was a cornerback and safety in the National Football League (NFL) for 14 seasons during the 1980s and 1990s. Lott played college football for the Univ ...
*
Hari Budha Magar Hari Budha Magar is a Nepalese double above-knee amputee and record-breaking mountaineer. In 2017, he became the first double above-knee amputee (DAK) to summit a mountain taller than 6,000m (Mera Peak, 6,476m). Early life Magar was born in ...
*
Kalamandalam Sankaran Embranthiri Kalamandalam Sankaran Embranthiri (1944–2007) was one of the most popular Kathakali musicians, credited with initiating a new wave in the rendition of songs for the classical dance-drama from Kerala in south India. His shruti-aligned music wa ...


See also

*
Acrotomophilia Acrotomophilia (from the Greek "having the top cut off" (from ' "extremity" and - from ' "I cut") and ' "love") is a paraphilia in which an individual expresses strong sexual interest ''in'' amputees. It is a counterpart to ''apotemnophilia'', ...
*
Adapted automobile In biology, adaptation has three related meanings. Firstly, it is the dynamic evolutionary process of natural selection that fits organisms to their environment, enhancing their evolutionary fitness. Secondly, it is a state reached by the po ...
*
Flail limb A flail is an agricultural tool used for threshing, the process of separating grains from their husks. It is usually made from two or more large sticks attached by a short chain; one stick is held and swung, causing the other (the swipple) to st ...
*
Robotic prosthesis control Robotic prosthesis control is a method for controlling a prosthesis in such a way that the controlled robotic prosthesis restores a biologically accurate gait to a person with a loss of limb. This is a special branch of control that has an emphasis ...


References


Further reading

* Miller, Brian Craig. ''Empty Sleeves: Amputation in the Civil War South'' (University of Georgia Press, 2015). xviii, 257 pp.


External links

{{Authority control Surgical removal procedures Acute pain Punishments