Johns Hopkins plastic and reconstructive surgeon Jaimie Shores, M. Amputation can be traumatic due to an accident or injury or surgical due to any of multiple causes such as blood vessel disease, cancer, infection, excessive tissue damage, dysfunction, pain, etc. A portion of the body could also be missing before birth, called congenital amputation. Healing, recovery and rehabilitation from a major amputation require a multidisciplinary approach.
A person undergoing an amputation may or may not use a prosthetic as part of the recovery plan. A person can experience a traumatic amputation from a motor vehicle, occupational or industrial accident or combat injury. A body part can be cut off or torn away in a severe accident, or it can be so badly damaged from a crush injury or severe burns that it cannot be saved.
Trauma or disease that cuts off blood flow to a body part for an extended time can also cause tissue death requiring an amputation. An example is frostbite, which can damage the blood vessels in fingers and toes, eventually requiring their removal.
Chronic vascular problems can lead to tissue death in toes, feet and legs. Of patients undergoing amputation for complications of these diseases, nearly half will die within five years of the amputation procedure. Cancers such as sarcomas can affect bone and soft tissue in the limbs, and if the cancer is too large or aggressive to be removed, if it is recurring, or if it extends into the nerves or blood vessels, amputation might be necessary.
Advanced cancers affecting the upper leg can result in an amputation procedure called hip disarticulation, which removes the entire femur thigh bone from the pelvis. Severe sepsis is also called septicemia or blood poisoning. It happens when drug-resistant bacteria overwhelm the body and spread throughout the bloodstream. Sepsis can affect blood flow and cause tissue to die, especially in the toes, fingers, hands and feet.
Severe sepsis can be deadly if antibiotic medicines cannot control the infection. One cause of sepsis is meningococcal bacteria, which cause a serious form of meningitis — an inflammation of the coverings of the brain and spinal cord. Methicillin-resistant staphylococcus aureas MRSA , also a bacterium, can cause a severe condition called necrotizing soft tissue infection , or fasciitis.
This is not a procedure, but a term that refers to a missing or incompletely formed hand, foot, arm or leg that is present at birth. The surgical approach depends on the affected body part, the reason for the amputation and the extent of bone and tissue damage.
A finger amputation may be a small but intricate procedure working with skin, tendons and nerves to allow fine motor function and optimal use of the hand. The removal of an arm or leg can call for major surgery, requiring skill in handling and stabilizing all the different tissues of the body part including skin, blood vessels, muscles, nerves, tendons and bone. To remove a finger, toe, foot, hand, arm or leg, the surgeon may cut through the bone or detach disarticulate a joint, separating bones where they meet such as in the knee or elbow.
The amputation may take place in stages. A revision procedure may be necessary to address tissue breakdown, chronic pain, scarring or other health issues. The buildup of sweat and dirt can lead to various skin issues, thanks to the bacteria that will form.
Additionally, your residual limb is likely to develop an odor. Aside from cleaning your stump every day, you can also try sprinkling some baking soda on the stump before wearing your prosthesis to help reduce the amount of sweat. Similarly, you can also apply some over-the-counter antiperspirant to the stump before donning the prosthesis. And while you are cleaning up, remember to clean the socket as well. The good news is the more you wear your prosthesis, the less you will perspire as your body gets used to its new normal.
Still, keep checking on your residual limb for any injuries — like blisters or tender areas —as well as your remaining limb, especially if the reason for your amputation was due to health issues, like diabetes. As with anything else in life, practice makes perfect, and donning your new prosthesis is no different. You may feel like that wearing a prosthesis will be exactly like having your amputated limb back, and while science and technology have come far enough for that to be closer to true, the human body still requires some level of training to adapt.
What is natural is how the human body responds to something like an amputation. When a limb is lost, the body will automatically put more of the burden on the remaining limbs to make up for the lost one. Prosthetic training is getting the body to unlearn what comes naturally and relearn how to function as if it was still working with all original limbs. For example, if you have had a leg amputated, your body's natural reaction will be to shift the burden on to the remaining leg.
But with a prosthesis, your body needs to learn how to evenly distribute the weight between the artificial and remaining leg. Continuing to place most of your weight on your remaining leg instead of on the prosthesis can cause various health problems down the line — and is likely to be uncomfortable. Regardless of which limb has been amputated, your body will need retraining to function properly with the prosthesis.
For example, leg or foot amputations will require gait training , which teaches your body how to walk naturally again instead of limping. This is crucial since the proper way of walking helps reduce the risk of multiple injuries in the back and legs. Gait training also helps take the pressure of the residual limb, which reduces the chances of injury.
Similarly, if you had an arm or hand amputation, you will need to relearn how to do many things you previously took for granted, such as how to get dressed by yourself. An occupational therapist will likely teach you tips and tricks to living independently with an amputation — both for doing things with and without your prosthesis. Putting on shoes, cooking dinner and even driving are all things that you will need to relearn, even with a prosthesis.
The reason is that the prosthesis is unable to mimic many of the very fine motor skills that human hands are capable of.
This does not mean that you cannot do things requiring fine motor skills, just that you have to learn new ways to do them. An occupational therapist will help you learn to mimic some of those fine motor skills, such as the ones needed for eating with cutlery or going up and down the stairs. The amount of time the training takes varies from person to person and can be further complicated by the type of prosthesis being used.
Each prosthesis requires specific training because no two artificial limbs are alike. You should know exactly how to use your own prosthesis so you can live a highly independent life. The main goal of prosthetic training and occupational therapy is independence. In the past, an amputation meant the end of your former life altogether. The technology was not advanced enough to allow amputees to do things independently. Instead, they were highly dependent on others. Today, technology and our understanding of the human body and mind have come so far that amputees no longer need to be dependent on others to live a fulfilling life.
With training, living aids and ongoing support, amputees can return to their independent lives. They can participate in sports, cook, drive — whatever they want. The effect of independence goes beyond just physical rehabilitation — it is also vital for emotional rehabilitation. Many feelings come with an amputation, and regaining independence can help you feel more like yourself. Being independent and returning to the tasks you once did without a second thought can also help you become more comfortable with your new body image and your new reality.
It can boost your self-confidence and help alleviate feelings of grief and anger that often accompany an amputation. No matter how much you prepare, you will likely still experience challenges you never considered. You may feel that an amputation limits what you can and cannot do, but those limitations are more like pushes to alter how you do things.
For someone with an arm or hand amputation, relearning how to do seemingly simple tasks, like brushing your teeth, may become a challenge. Someone who has had a leg amputation will inevitably need to relearn how to walk and run. Luckily, living aids can assist those with amputations and encourage them to live more independent lives.
From tools to help chop up vegetables to handlebars to make climbing in and out of the bath easier, almost anything that a non-amputee can do, an amputee can do as well. Bathroom activities are often the most concerning for new amputees. Even if you do not mind asking for help in the kitchen or with household chores, everyone prefers to tend to bathroom duties by themselves. As mentioned, because prostheses are unable to mimic the fine motor skills needed for certain tasks — such as holding a toothbrush to brush teeth properly — living aids help make these tasks a bit easier.
You can even make some do-it-yourself living aids , like wrapping some tape or other anti-slip devices on a toothbrush to help the prosthesis grip it better. As we mentioned, the emotional impact of an amputation can be severe and there is no wrong way to deal with your amputation. Grief, anger, depression are just some of the possible emotions you will feel — and they are all valid and very normal.
The important thing is how you cope with these feelings, whatever they are. There are healthy and unhealthy ways to cope with an amputation. For example, refusing to deal with the reality and impact of your amputation is an unhealthy way to cope. Here are some healthy ways for dealing with amputation:. Rehabilitation is an ongoing process, so make sure the support you have is ongoing as well. While peer support is crucial, so is the support of your rehabilitation team. Your general practitioner, physiotherapist, prosthetist, and therapist are just some of the members of your ongoing support team — people you will build relationships with and see for many years following your amputation.
Ongoing support is also where your loved ones can get support — they will likely feel a level of grief and loss or even just stress due to your amputation.
Providing ongoing support to you and your loved ones ensures that you never suffer. Whether you are a brand new amputee or have been one for decades, no one is immune to needing help sometimes.
Although you may need it less as you grow older, it is unlikely that a time will come when you do not need any support whatsoever. Despite advancements in technology, issues with prostheses are not one-off issues, so your prosthetist will remain in your life indefinitely to help with any issues or concerns that occur. Emotional rehabilitation is seldom ever complete, so your therapist or counselor will also remain in your life to help you continue to cope with your new reality.
Plus, emotional reactions can fluctuate from week to week — the bottom line is that you will never be alone. We know the importance of ongoing support, which is why our program also offers post-discharge services for you and your family. If you are looking for experienced, professional clinicians to join your ongoing support rehabilitation team, find a PAM Health location near you and schedule a tour of the hospital. Toggle navigation. Location or Specialization Health Providers Browse Site Search.
What to Expect Immediately After Amputation When you have decided that amputation is necessary, you will want to understand what to expect before the surgery and after the surgery. Before the Surgery You will likely have a rehabilitation team that will include surgeons, nurses, physical therapists, occupational therapists and social workers. During the Surgery When amputating a limb, the surgeon will also remove any damaged tissue, leaving as much healthy tissue as possible. After the Surgery The first day after the surgery is often the hardest as you process that what was previously just theoretical is now a reality.
The Healing Process What is the recovery after amputation like? The healing process begins with three main components: Physical therapy and rehabilitation Managing the risk of complications Gaining mobility and independence If you plan on getting a prosthesis, it may be months before you are fitted for your artificial limb, which makes physical therapy one of the most important parts of your recovery.
Physical Therapy and Rehabilitation A part of rehabilitation is strengthening the muscles in your remaining limbs, and another part is helping you work towards independence. Managing the Risk of Complications Like with any major surgery, there are risks of complications involved with amputations. These can include: Heart problems, including heart attacks Deep vein thrombosis, which is a fancy way of saying a blood clot that forms in the veins of your legs A slowdown of healing, potentially due to infection Pneumonia Phantom limb syndrome, which is common for amputees The need for further surgery is also a potential, especially if there is pain, such as from nerves that have thickened, or if more tissue needs to be removed.
Gaining Mobility and Independence Once you are discharged from the hospital, you will need to learn how to do everyday activities with your revised body.
Long-Term Care and the Road to Recovery When it comes to the long term, there are two parts of the recovery process: Physical recovery Emotional recovery Both physical and emotional recovery is something you will be doing from the time of your surgery on, but while physical recovery likely has an end date, emotional recovery can be ongoing. Physical Recovery Physical recovery includes physiotherapy, which you will likely have to do three to five times a week. Emotional Recovery There are no wrong feelings when it comes to amputation, which is why emotional recovery is as important as physical recovery.
Three key reasons an amputation can have such a strong effect on a person's life are: Getting used to the lack of feeling and sensation in the amputated limb.
Amputation is the last option. Non-infected gangrene of the fingers and toes can be treated by amputation or can be allowed to "autoamputate" tissue dies and sloughs off on its own over a period of time, usually months. Gangrene of other extremities requires amputation. Infected gangrene should be treated with the goal of getting rid of the infection yet preserving as much of the extremity as possible.
Dead or dying infected tissue should be removed debridement as quickly as possible. Tissue that is infected but may likely heal should be left. And the person should receive intravenous antibiotics. If a person is not stable or does not respond to antibiotic treatment and debridement, amputation must be done rapidly. A first emergency amputation is often done with the goal of stabilizing the person. And a second elective operation may be done to remove any further dead tissue and to improve the function of the remaining limb.
Szalay MD - Vascular Surgery. Author: Healthwise Staff. Medical Review: Rakesh K. This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use and Privacy Policy. Learn how we develop our content. To learn more about Healthwise, visit Healthwise.
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