Traumatic amputation involves the accidental loss of a body part, usually a finger, a toe, an arm, or a leg. In complete amputation, the member is totally severed; in partial amputation, some soft-tissue connection remains.
The prognosis has improved as a result of early improved emergency and critical care management, new surgical techniques, early rehabilitation, prosthesis fitting, and new prosthesis design. New limb reimplantation techniques have been moderately successful, but incomplete nerve regeneration remains a major limiting factor.
Traumatic amputations usually result directly from accidents at a factory or farm, or from power tools or motor vehicle accidents.
Any patient with a traumatic amputation requires careful monitoring of vital signs as well as assessment for other traumatic injuries. If amputation involves more than just a finger or a toe, assessment of airway, breathing, and circulation is also required. Because profuse bleeding is likely, watch for signs of hypovolemic shock, and draw blood for hemoglobin level, hematocrit, and typing and crossmatching. If the patient has a partial amputation, check for pulses distal to the amputation.
Because the greatest immediate threat after traumatic amputation is blood loss and hypovolemic shock, emergency treatment consists of local measures to control bleeding, fluid replacement with normal saline solution and colloids, and blood replacement as needed.
Reimplantation remains controversial, but it’s becoming more common and successful because of advances in microsurgery. If reconstruction or reimplantation is possible, surgical intervention attempts to preserve usable joints. When arm or leg amputations are done, the surgeon creates a stump to be fitted with a prosthesis. A rigid dressing permits early prosthesis fitting and rehabilitation.
CLINICAL TIP: After complete amputation, wrap the amputated part in a dry, sterile towel, and put it in a plastic bag. Keep the bag cool, but not cold enough to damage or freeze the amputated part. Flush the wound with sterile saline solution, apply a sterile pressure dressing, and elevate the limb. Notify the reimplantation team.
Review other book chapters online related to Amputation:
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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Title: Handbook of Diseases Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 1-58255-266-5 
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