Traumatic amputation
Traumatic amputation: Excerpt from Professional Guide to Diseases (Eighth Edition)
Traumatic amputation is the accidental loss of a body part, usually a finger, toe, arm, or leg. In a complete amputation, the member is totally severed; in a partial amputation, some soft-tissue connection remains. The prognosis for such injuries has improved as a result of earlier 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.
Causes and incidence
Traumatic amputations usually result directly from accidents involving factory, farm, power tools, or motor vehicles. Natural disasters, wars, and terrorist attacks can also cause traumatic amputations.
Below the knee amputations account for 53% of traumatic leg amputations; with about 33% above the knee. Lower limb amputations account for 91.7% of traumatic amputations. Incidence of below the elbow amputation is 4.4%, and above the elbow amputations account for 2%.
Signs and symptoms
The obvious sign of amputation is a body part that has been cut off. Every traumatic amputee requires careful monitoring of vital signs. If amputation involves more than a finger or 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 a hemoglobin level, hematocrit, and type and crossmatch. In partial amputation, check for pulses distal to the amputation site. After any traumatic amputation, assess for other traumatic injuries as well. The patient may exhibit crushed body tissue, in which the body part is badly mangled but still partially attached by muscle, bone, tendon, or skin.
Treatment
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 techniques. 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.
ELDER TIP Leg amputation can be a life-threatening procedure, especially in patients older than age 60 with peripheral vascular disease. Such patients suffer significant morbidity with above-the-knee amputations because of associated poor health, disease, or malnutrition; complications such as sepsis; and the physiologic insult of amputation.
Special considerations
❑ During emergency treatment, monitor vital signs (especially in hypovolemic shock), clean the wound, and give tetanus prophylaxis, analgesics, and antibiotics as ordered.
❑ After a complete amputation, wrap the amputated part in wet dressings soaked in normal saline solution. Label the part, seal it in a plastic bag, and float the bag in ice water. Flush the wound with sterile saline solution, apply a sterile pressure dressing, and elevate the limb. Notify the reimplantation team.
❑ After a partial amputation, position the limb in normal alignment and drape it with towels or dressings soaked in sterile normal saline solution.
❑ Preoperatively, irrigate and debride the wound thoroughly (using a local block). Postoperatively, perform dressing changes using sterile technique to help prevent skin infection and ensure skin graft viability.
❑ Help the amputee cope with his altered body image. Encourage him to perform prescribed exercises while taking care to prevent stump trauma.
Book Source Details
- Book Title: Professional Guide to Diseases (Eighth Edition)
- Author(s): Springhouse
- Year of Publication: 2005
- Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2005 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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