Overview
Limb amputation is the surgical removal of all or part of your arm or leg, e.g., a hand, foot, finger or toe. You may require a limb amputation either due to a traumatic injury such as an accident or sports injury, or in case you have a medical condition like an infection or a vascular disease (peripheral arterial disease). You may also have a missing limb before birth which is called congenital amputation.
Why do you need limb amputation?
You may need limb amputation for a number of reasons such as:
- A traumatic injury that causes so much damage to your limb that it cannot be saved. About 45% of all amputations result from a traumatic injury such as an accident or combat injury1
- An infection in your limb may require it to be surgically removed to prevent the infection from spreading
- Peripheral arterial disease (PAD) damages the blood vessels that are carrying blood to your limbs. Loss of blood supply causes the death of your tissues (gangrene). Tissues that are about to die are more vulnerable to infection and thus sepsis may occur if you don’t have your limb amputated2,3
- If diabetes is not managed properly, it can lead to peripheral neuropathy (nerve damage) and peripheral arterial disease (PAD). PAD causes reduced blood flow towards your feet and legs so cuts and wounds heal slowly), while peripheral neuropathy may mean you can’t feel cuts or sores on your feet. If these cuts develop into an infection, then your physician may ask you to have lower limb amputation (amputation of feet, toes, legs)
- Although not very common, cancer may also require you to have a limb amputation to prevent the spread of cancer. These cancer-related limb amputations account for less than 2% of all amputations1
What are the signs leading to limb amputation?
You should be aware of the signs and symptoms that indicate you may need your limb to be amputated in the future. Being aware of these warning signs and managing them can reduce your chances of requiring a limb amputation. These warning signs or symptoms are as follows:4
- Numbness in your leg or foot
- Persistent (non-healing) wounds
- Pain in your leg or foot
- Thickening nails
- Gangrene
- Non-healing infections
- Weak pulse in one or both legs
What are the types of limb amputation?
Upper limb amputation
Upper limb amputations include separating either the entire arm or only a portion of your forearm, upper arm, or hand. These types include:1
1. Partial hand amputation
It involves the removal of a part of your hand.
2. Forearm amputation
It is also known as ‘below-the-elbow amputation’ and involves the removal of a portion of your lower arm (forearm) by cutting across the bones in your forearm (the radius and ulna).
3. Upper arm amputation
Upper arm or above-the-elbow amputation requires cutting across the bone in your upper arm (the humerus) to remove a section of the upper and lower arm.
4. Wrist disarticulation
It involves removing your hand by separating it from the forearm at the wrist joint.
5. Elbow disarticulation
It is the removal of the lower arm and hand from the upper arm at the elbow joint.
6. Shoulder disarticulation
It is the surgical separation of your entire arm at the shoulder joint.
Lower limb amputation
1. Partial foot amputation
It involves only the removal of a part of your foot.
2. Below-knee amputation
Below-the-knee amputation involves cutting across the tibia and fibula which are the bones present in your lower leg. It removes a part of your lower leg and your foot.
3. Above-knee amputation
Above-the-knee amputation cuts across the femur which is the bone in your upper leg and removes your lower leg, knee joint and a portion of your upper leg.
4. Ankle disarticulation
It involves the removal of your foot by separating it from your lower leg at the ankle joint.
5. Knee disarticulation
Knee disarticulation is the removal of your lower leg by separating it from the upper leg at the knee joint.
6. Hip disarticulation
Hip disarticulation is the removal of your entire leg by separating it from the pelvis at the hip joint.
How is limb amputation surgery done?
The following stages are carried out as part of the limb amputation surgery:
Anaesthesia
Anaesthesia is the process where you are given medication (anaesthetics) that causes a loss of sensation. This means you won’t feel pain during the procedure.5 Limb amputations are done either under general anaesthesia (where you are made unconscious) or under spinal or epidural anaesthesia (which numbs the lower half of your body). The choice of e anaesthesia approach depends on what type of limb amputation is being carried out.3
Amputation surgery
Limb amputation is carried out with utmost care so that your remaining limb stays functional and the risk of complications is reduced. In addition, healthy tissue will be kept intact as much as possible. In case you require a prosthetic device (artificial body part) after the surgery, the amputation should make certain that the prosthesis fits perfectly and functions properly. The following steps are performed by your surgeon during an amputation surgery:2,3
- Eliminates all the damaged and diseased tissue as well as crushed bone
- Shortens and smooths the bone in the remaining portion of your limb (so that it is enfolded by a sufficient mass of soft muscle and tissue
- Seals up the blood vessels so that bleeding is prevented
- Stitches the muscle to the end of the residual bone to retain maximum strength in your limb (a process known as myodesis)3
- Shapes the muscle in such a way that the stump (the end of the amputated limb) can be fixed with a prosthetic limb if required
- Seals the wound with stitches and places a sterile bandage over it. A drainage tube may also be kept under your amputated limb to drain any excess fluid3
Recovery after amputation
After the surgery, you may be given painkillers to deal with any pain or discomfort. A physiotherapist may be assigned to teach you exercises so that blood clots can be prevented and your blood supply is improved while you are still recovering. A compression garment helps in shaping the stump and reducing swelling, in addition to lessening phantom limb pain (pain that seems to be coming from your amputated limb).6 You may be offered a wheelchair or walking aid such as a walker or walking stick to help you move around.
Prosthetic limbs
Adjusting to life with a prosthetic limb is time-consuming and requires significant effort. A comprehensive course of physiotherapy and rehabilitation is required after you receive a prosthetic limb.7
You will be taught different exercises to help you get accustomed to the artificial limb. Fixing a prosthetic usually takes place after the incision has healed properly and six to eight weeks after the amputation surgery.
What are the complications of limb amputation?
Limb amputation carries certain complications, as is common with other surgical procedures. Planned amputations have a lower risk of causing severe complications than emergency amputations. The following complications are linked with limb amputations:2
- Swelling
- Infection
- Phantom limb pain
- Wounds
- Bleeding
- Muscle weakness
What is phantom limb pain?
Phantom limb pain is the most common complication associated with limb amputation. It occurs when nerves present in your stump convey pain signals to your brain even though your limb has been removed. Although this pain goes away with time, techniques can be used to reduce it after surgery, such as the use of compression garments and physiotherapy.2
FAQs
When does limb amputation become necessary?
Limb amputation is needed after a traumatic injury (such as an accident), vascular diseases (peripheral arterial disease), infection, and sometimes due to cancer.
How is limb amputation performed?
Limb amputation is generally performed through surgery and involves the removal of all or part of your limb. The surgical procedure may differ depending upon certain circumstances and the type or level of limb amputation that is required.
What are some potential complications of limb amputation?
Complications with limb amputation include infection, nerve damage, bleeding, swelling, and issues related to wound healing. In addition, adapting to life with an amputation is associated with psychological and emotional challenges.
How does rehabilitation work after limb amputation?
Rehabilitation after limb amputation helps in regaining mobility and assists you in getting accustomed to the artificial limb. It involves physiotherapy, occupational therapy, and psychological support to help you get used to the prosthetic limbs.
Summary
Limb amputation is the removal of all or part of your arm or leg. Limb amputation may be needed in cases of traumatic injury, a persistent infection, certain diseases (e.g., peripheral arterial disease, peripheral neuropathy), and sometimes cancer. Limb amputation also prevents the spread of infection and manages pain when there is no other choice.
Having your limb amputated doesn’t mean you’re incapable of having a normal life as there are ways to make you independent after surgery. You can have an artificial limb (prosthesis) fitted to your stump or you may choose to make use of a walking aid (such as a cane, stick, or walker). You will also be assisted by an occupational therapist or physiotherapist in learning how to take part in your day-to-day activities after amputation.
References
- Amputation [Internet]. 2023 [cited 2024 Jan 26]. Available from: https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/amputation.
- Amputation: definition, indications & recovery. Cleveland Clinic [Internet]. [cited 2024 Jan 26]. Available from: https://my.clevelandclinic.org/health/treatments/21599-amputation.
- Amputation. nhs.uk [Internet]. 2017 [cited 2024 Jan 26]. Available from: https://www.nhs.uk/conditions/amputation/.
- Limb Loss Diseases & Conditions That May Lead to an Amputation [Internet]. [cited 2024 Jan 26]. Available from: https://primecareprosthetics.com/blog/what-causes-amputation-causes-symptoms-and-risk-factors-of-limb-loss.
- Amputations. Physiopedia [Internet]. [cited 2024 Jan 27]. Available from: https://www.physio-pedia.com/Amputations.
- Finding your Feet [Internet]. Recovering after amputation; [cited 2024 Jan 27]. Available from: https://findingyourfeet.net/amputations/recovering-after-amputation/.
- Amputation: Recovery and Rehabilitation [Internet]. 2023 [cited 2024 Jan 27]. Available from: https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/amputation/amputation-recovery-and-rehabilitation.