Amputation is the removal of limbs with trauma, medical illness, or surgery. As a surgical action, it is used to control the pain or disease process in affected limbs, such as malignancy or gangrene. In some cases, it is done on the individual as a preventive operation for such problems. A special case is a congenital amputation, a congenital disorder, in which the limbs of the fetus are cut by a constricting tape. In some countries, amputation of the hands, feet or other body parts is used as a form of punishment for the person committing the crime. Amputation has also been used as a tactic in war and acts of terrorism; it can also happen as a war injury. In some cultures and religions, small amputations or mutilations are perceived as ritual accomplishments.
In the US, the majority of new amputations occur due to complications of the vascular system (blood vessels), especially of diabetes. Between 1988 and 1996, there was an average of 133,735 hospital discharges for amputation per year in the US.
Video Amputation
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Lower limbs, or legs, amputations can be divided into two broad categories - light amputations and large amputations, small amputations generally refer to digit amputations. Major amputations are usually called amputations below the knee, amputations above the knee, and so on. To avoid ambiguity, the correct terminology for large amputations is described in ISO 8549-2: 1989, these are:
- partial leg amputation - amputation lower extremity distal to ankle joint .
- the ankle-articulated - amputation of the lower extremities on the ankle joint .
- trans-tibial amputation - lower limb amputation between knee joint and ankle joint , commonly referred to as knee amputation.
- articulated knee - cutting of the lower on the knee joint .
- trans-femoral amputations - lower extremity amputations between hip joint and knee joint , commonly referred to above the amputation knee.
- pelvicular pelvic - amputation of lower extremities in hip joint .
- trans-pelvic disarticulation - amputation of the entire lower limb along with all or part of the pelvis. This is also known as hemipelvectomy or hindquarter amputation.
Common partial leg amputations include Chopart, Lisfranc and amputation of light, Common forms of ankle disarticulation include Syme, Pyrogoff and Boyd. The less common major amputation is the rotation/rotation of the Van Ness Vertic (the legs are rotated and glued to allow the ankle joints to be used as knees).
Arm
The correct terminology for amputation of the arm or upper amputation is also described in ISO 8549-2: 1989, these are:
- partial hand amputation
- wrist articulated
- trans-radial amputation, usually called lower-angled amputation or forearm
- elbow disarticulated
- trans-humerus amputation, commonly called an amputation above the elbow
- bearticulated shoulder
- forequarter amputation
Trans-radial amputation variant is the Krukenberg procedure in which radius and ulna are used to make stubble capable of clamping.
More
- Face:
- amputation of the ear
- nasal amputation (rhinotomy)
- amputation of the tongue (glossectomy).
- eye cutting (enukleasi). Much of the defamation of this face and is still done in some parts of the world as punishment for some crimes, and as a shame of individuals and the practice of population terror.
- tooth cutting. Teeth removal, especially incisors, is or is practiced by some cultures for ritual purposes (eg in the North African Neolithic Iberomaurusian culture).
- Breasts:
- breast amputation (mastectomy).
- Genitals:
- amputation of the testes (castration).
- amputation of the penis (penectomy).
- amputation of the foreskin (circumcision).
- clitoral amputation (clitoridectomy).
Hemikorporektomi, or amputation at the waist, and beheadings, or amputations in the neck, is the most radical amputation.
Genital modification and mutilation can involve amputation tissue, although not always as a result of injury or disease.
Automatic forgery
In some rare cases when a person is trapped in a lonely place, without means of communication or rescue hope, the victim has amputated his own limbs. The most important case is Aron Ralston, a pedestrian who amputates his own right arm after being squeezed by a large rock in a hiking accident and he can not free himself for more than five days.
Impaired identity of body integrity is a psychological condition in which an individual feels the need to remove one or more of their body parts, usually limbs. In some cases, the individual may take drastic measures to eliminate the offending apparatus, either by causing damage to the irreversible extremities so that medical intervention can not save the extremities, or by causing the extremities to be cut off.
Maps Amputation
Cause
Circulatory Disorder
- Diabetic foot infection or gangrene (the most frequent reason for infection-related amputation)
- Sepsis with peripheral necrosis
Neoplasm
- Bone tumors or soft-tissue cancer (eg osteosarcoma, chondrosarcoma, fibrosarcoma, epithelioid sarcoma, Ewing's sarcoma, synovial sarcoma, sakrokoksigeal teratoma, liposarcoma)
- Melanoma
Trauma
- Extreme extremity injuries in which limbs can not be stored or attempts to save limbs fail.
- Traumatic amputation (unexpected amputation occurring at the scene of the accident, in which the limb is partially or completely disconnected as a direct result of an accident, for example, a finger cut off from a table saw blade)
- Amputation in utero (Amniotic Band)
Form abnormality
- Numerical deformities and/or limbs (eg, focal proximal femoral deficiency, Fibular hemimelia)
- Extras digits and/or limbs (e.g., polydactyly)
Infection
- Bone infection (osteomyelitis)
- Diabetes
- Frostbite
Athletic performance
- Sometimes professional athletes may choose to have an amputated non-essential digit to relieve chronic pain and performance disruption. Australian Rules footballer Daniel Chick chose his amputated left index finger due to illness and chronic injuries that limited his appearance. Rugby unionist Jone Tawake also has a finger removed. The National Football League Security, Ronnie Lott, has the tip of his little finger removed after being damaged in the 1985 NFL season.
Legal penalty
- Amputation is used as a legal punishment in a number of countries, including Saudi Arabia, Yemen, United Arab Emirates, Iran
Surgery
Method
The first step is to connect the arterial and venous supply, to prevent bleeding (bleeding). The muscles are trans- mitted, and finally, the bone is sawn with an oscillating saw. Sharp and rough ends of the bone (s) are filed down, the skin and the muscle flap are then diverted through the stump, sometimes by insertion of the element to attach the prosthesis.
Stabilization of distal muscles is recommended. This allows effective muscle contraction that reduces atrophy, enabling the functional use of the stump and maintaining soft tissue coverage of the remaining bone. The preferred stabilization technique is the miodesis in which the muscle is attached to the bone or periostium. In disarticulation tentodesis amputations can be used in which the muscle tendon is attached to the bone. Muscles should be placed under the same tension as normal physiological conditions.
The experimental technique known as "Ewing amputation" aims to improve post-amputation prioperception.
Post-operative management
The use of removable rigid dressings (RRD's) on trans-tibial amputations (below the knee), rather than soft swelling has been shown to increase healing time, reduce edema, prevent knee flexion contractions and reduce complications, including further amputations, from external trauma such as falling to stump and should be considered standard practice.
Postoperative management, in addition to wound healing, should consider the maintenance of limb strength, joint coverage, edema management, preservation of whole limbs (if present) and desensitization of stumps.
Trauma
Traumatic amputation is the partial or whole avulsion of the body parts during serious accidents, such as traffic, labor, or combat.
Traumatic amputation of the human limbs, either partial or total, creates a direct danger of death from blood loss.
Orthopedic surgeons often assess the severity of different injuries by using a Measure of Measured Extremely Severity. Given the different clinical and situational factors, they can predict the possibility of amputations. It is very useful for emergency physicians to evaluate patients quickly and decide on consultations.
Cause
Traumatic ammunition is rare in humans (1 per 20,804 population per year). Loss of limbs usually occur immediately during an accident, but sometimes a few days later after a medical complication. Statistically the most common causes of traumatic amputation are:
- Traffic accidents (cars, motorcycles, bicycles, trains, etc.)
- Labor accidents (equipment, instruments, cylinders, chain saws, press machines, meat machines, wood machines, etc.)
- Agricultural accidents, with machines and lawn mowers
- The hazard of electric shock
- Firearms, sharp weapons, explosives
- Wrong rope of industrial ship or wire rope
- Traction ring (amputation ring, de-gloving injury)
- Building doors and car doors
- Gas cylinder explosion
- Another rare accident
Treatment
The development of micro surgery over the past 40 years has provided several treatment options for traumatic amputation, depending on the patient's specific trauma and clinical situation:
- First choice: Surgical amputation - rest - prosthesis
- Second choice: Surgical amputation - another tissue transplant - plastic reconstruction.
- Option 3: Replantation - reconnection - revascularization of amputated limbs, by microscope (after 1969)
- Fourth option: Cadaver hand transplant (after 2000),
Epidemiology
- In the United States in 1999, there were 14,420 non-fatal traumatic amputations according to the American Statistical Association. Of these, 4,435 occurred as a result of traffic and transport accidents and 9,985 were caused by work accidents. Of all traumatic amputations, the percentage of distribution was 30.75% for traffic accidents and 69.24% for occupational 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 people per year. In the amputation group work, 53% occurred in workers and technicians, 30% in production and service workers, 16% in silviculture and fisheries workers.
- One study found that in 2010, 22.8% of patients undergoing lower extremity amputation in the United States were admitted back to the hospital within 30 days.
Prevention
Amputation is usually a traumatic experience. They can reduce the quality of life of patients in addition to expensive. In the US, the cost of typical prosthetic members is in the range of $ 10,000-15,000 according to the American Diabetic Association. In some populations, preventing amputation is a very important task.
Methods in preventing amputations, motion-saving techniques, depending on the problem that may cause amputation are required. Chronic infection, often caused by diabetes or decubitus ulcers in bed-bed patients, is a common cause of infection that causes gangrene, which would then require amputation.
There are two main challenges: first, many patients experience circulatory disturbances in their extremities, and secondly, they have difficulty curing limb infections with poor vasculation (blood circulation).
Destructive injuries where there is extensive tissue damage and poor circulation also benefit from hyperbaric oxygen therapy (HBOT). High levels of oxygenation and revascularization speed up recovery time and prevent infection.
One study found that a patented method called Circulator Boot achieved significant results in the prevention of amputation in patients with diabetes and arteriosclerosis. Another study found it was also effective for ulcer wound healing caused by peripheral vascular disease. Boot checks heart rhythm and suppresses extremity between heartbeat; compression helps heal wounds in the walls of blood vessels and arteries, and helps push the blood back to the heart.
For trauma survivors, the advent of microsurgical surgery in 1970 has made replantation of the disconnected body parts possible.
The establishment of laws, rules, and guidelines, and the use of modern equipment help protect people from traumatic amputations.
Prognosis
Individuals may experience psychological trauma and emotional discomfort. The stump will remain an area that reduces mechanical stability. Losing limbs can present significant or even drastic practical limitations.
Most amputations (50-80%) have phenomenon of ghost limbs; they feel the parts of the body that no longer exists. These limbs can be itchy, sick, burn, feel tense, dry or wet, locked or trapped or they can feel as though they are moving. Some scientists believe it has to do with the kind of neural map the brain possesses of the body, which sends information throughout the brain about limbs regardless of their existence. Phantom sensation and phantom pain may also occur after removal of body parts other than limbs, eg after breast amputation, tooth extraction (phantom tooth pain) or eye removal (phantom eye syndrome).
A similar phenomenon is an unexplained sensation in a part of the body unrelated to an amputated limb. It has been hypothesized that the part of the brain responsible for processing the stimulation of the amputated limbs, which loses input, extends to the surrounding brain, ( Phantom in the Brain : VS Ramachandran and Sandra Blakeslee) so that an individual possesses the amputated arm will experience unusual pressure or movement on the face or head.
In many cases, phantomal branches help in adapting to the prosthesis, as it allows people to experience the proprioception of prosthetic limbs. To support increased durability or usefulness, comfort or healing, some types of stump socks may be used as a substitute or as part of the use of prosthesis.
Other side effects can be heterotopic ossification, especially when a bone injury is combined with a head injury. The brain signifies bone growth rather than scar tissue to form, and nodules and other growths may interfere with prosthetics and sometimes require further surgery. This type of injury is very common among soldiers wounded by improvised explosive devices in the Iraq War.
Due to technological advances in prosthetics, many people who are amputated live actively with few restrictions. Organizations such as the Challenged Athletes Foundation have been developed to allow amputees to engage in athletic and adaptive sports such as Amputee Football.
History
The amputation word comes from the Latin amputare , "to cut", from ambi - ("about", "around") and putare (" Cut"). The English word "amputation" was first applied to operations in the 17th century, probably first in Peter Lowe. A discourse from the Whole Art of Chirurgerie (published in 1597 or 1612); his work is derived from 16th-century French texts and early English writers also used the word "extirpation" (16th century French texts tend to use extirper, disarticulation, and "cut up" (from The ancient French desmembrer and more general terms before the seventeenth century for loss or removal of limbs), or simply "cutting", but by the end of the 17th century "amputation" had dominated as a medical term be accepted.
Famous cases
- Terry Fox
- Bethany Hamilton
- Oscar Pistorius
- Frida Kahlo
- Amy Purdy
- Pete Gray
- Aimee Mullins
- Aron Ralston
- Hugh Herr
- Robert David Hall
- Douglas Bader
- Shaquem Griffin
- Tammy Duckworth
See also
- Customize cars
- Prosthesis
- Acrotomophilia
- Control of robotic prosthesis
References
Further reading
- Miller, Brian Craig. Empty Sleeve: Amputation in Southern Civil War (University of Georgia Press, 2015). xviii, 257 pp.
External links
- Amputation from Cooper's 1835 "Surgical Practice"
- Lower Boundary Amputation Imagery
- Blog amputation and regeneration
- Diving In, NC Well Magazine
- Limbs4Life Steps for Recovery. Information for new amputation sufferers and their caregivers.
- Limb Loss Education, University of Washington
- Lunarity Extremity Breakout Scores
- The Afghan amputees tell their story at the Texas meeting of the Fayetteville Observer.
- Can modern prosthetics really help reclaim a sense of touch ?, PBS Newshour
Source of the article : Wikipedia
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