10.5 Amputation
Amputation refers to the surgical removal of a body part. The psychosocial impact of amputation often surpasses the physical impairment as individuals may experience emotional distress, body image concerns, and adjustments to their daily lives.
The two primary categories of amputation are elective and traumatic:
- Elective Amputation: Elective amputation is planned and performed due to medical conditions such as severe infection, tumors, or vascular diseases that compromise blood flow to the affected limb. It is often a proactive decision made by health care professionals and the client to prevent complications like sepsis and metastasis.[1] Including the client during decision-making helps in the healing and acceptance stage after the surgery.
- Traumatic Amputation: Traumatic amputation occurs due to accidents, injuries, or severe trauma, resulting in the sudden loss of a limb. Traumatic amputations can significantly impact an individual’s ability to cope with the loss due to its unexpected and immediate impact on their life.[2]
Amputations are classified based on the location in the upper or lower extremity. Lower extremity amputations include the following[3]:
- Toe or Partial Foot Amputation: Removal of toes or a part of the foot that preserves the foot structure, aiding in maintaining balance and mobility
- Ankle Disarticulation: Amputation at the ankle joint, preserving the heel pad for weight-bearing and prosthetic fitting
- Below-Knee (Transtibial) Amputation: Amputation below the knee joint, providing a longer residual limb for better prosthetic control and energy-efficient walking
- Above-Knee (Transfemoral) Amputation: Amputation above the knee joint, requiring more energy for mobility due to the absence of the knee joint and increased leverage requirements
Upper extremity amputations are as follows[4]:
- Finger or Partial Hand Amputation: Removal of fingers or part of the hand
- Wrist Disarticulation: Amputation at the wrist joint
- Below-Elbow (Transradial) Amputation: Amputation below the elbow joint
- Above-Elbow (Transhumeral) Amputation: Amputation above the elbow joint
After an amputation is performed and the incision site is healed, the client may receive an artificial body part called a prosthesis to promote mobility and/or function. See Figure 10.25[5] for an illustration of a prosthesis used for an above-the-knee amputation.
Potential Complications
Several complications can occur after an amputation, including the following[6],[7]:
- Hemorrhage: Hemorrhage refers to excessive bleeding during or after surgery. It can be caused by inadequate closure of blood vessels, clotting disorders, or medications that impact clotting.
- Infection: Infection can occur due to contamination during surgery or wound care. Symptoms include redness, swelling, tenderness, purulent discharge, and fever.
- Phantom Limb Pain: Phantom limb pain is the sensation of pain or discomfort in the limb that was removed. It is a common neurol