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Amputations are performed to remove extremities that are severely diseased, injured, or no longer functional. Although medical advances in antibiotics, trauma care, vascular surgery, and the treatment of neoplasms have improved the prospects for limb salvage, in many cases, prolonged attempts to save a limb that should be amputated lead to excessive morbidity or even death. To counsel a patient regarding amputation versus limb salvage adequately, the physician must provide sufficient information about the surgical and rehabilitative steps involved with each procedure and must also appraise the probable outcome for function realistically with each alternative. Attempting to salvage a limb is not always in the best interest of the patient.
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The decision to amputate is an emotional process for the patient, the patient's family, and the surgeon. The value of taking a positive approach to amputation cannot be overemphasized. It is not a failure and should never be viewed as such. The amputation is a reconstructive procedure designed to help the patient create a new interface with the world and to resume his or her life. The residual limb must be surgically constructed with care to maintain muscle balance, transfer weight loads appropriately, and assume its new role of replacing the original limb.
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For patients to achieve maximal function of the residual limb, they also need a clear understanding of what to expect for an early postoperative prosthetic fitting, a rehabilitation program, and long-term medical and prosthetic needs. For these discussions, the team approach to meeting the patient's needs can be especially rewarding. Nurses, prosthetists, physical and occupational therapists, and amputee support groups can be invaluable in providing the physical, psychological, emotional, and educational support needed in returning patients to a full and active life. Many new amputees state that a peer visitor program was one of the most helpful events during their hospitalization and rehabilitation. The Amputee Coalition of America, a not-for-profit organization, supports this peer visitor training and can help locate programs that are available throughout the country.
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In infants and children, amputations are frequently associated with congenital limb deficiencies, trauma, and tumors. Traumatic amputations in children in 2003 in the United States resulted in $22 million in inpatient costs for 946 cases. The majority of amputations were finger and thumb, but the highest costs were due to traumatic leg amputations. Congenital limb deficiencies are commonly described using the Birch revision of the Frantz and O'Rahilly classification system. Amelia is the complete absence of a limb; hemimelia is the absence of a major portion of a limb; and phocomelia is the attachment of the terminal limb at or near the trunk. Hemimelias can be further classified as terminal or intercalary. A terminal hemimelia is a complete transverse deficit at the end of the limb. An intercalary hemimelia is an internal segmental deficit with variable distal formation. In discussions of limb deficiencies, preaxial refers to the radial or tibial side of a limb, and postaxial refers to ...