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Amputation is the removal of a body extremity by trauma or surgery. As a surgical measure, it is used to control pain or a disease process in the affected limb, such as malignancy or gangrene. In some cases, it is carried out on individuals as a preventative surgery for such problems.
Types of Amputation:
- amputation of digits
- partial foot amputation (Chopart, Lisfranc)
- ankle disarticulation (Syme, Pyrogoff)
- below-knee amputation (transtibial)
- knee-bearing amputation (knee disarticulation)
- above knee amputation (transfemoral)
- Van-ness rotation (Foot being turned around and reattached to allow the ankle joint to be used as a knee.)
- hip disarticulation
- amputation of digits
- metacarpal amputation
- wrist disarticulation
- forearm amputation (transradial)
- elbow disarticulation
- above-elbow amputation (transhumeral)
- shoulder disarticulation and forequarter amputation
- Hemicorporectomy, or amputation at the waist, is the most radical amputation.
- Genital modification and mutilation may involve amputating tissue, although not necessarily as a result of injury or disease.
As a rule, partial amputations are preferred to preserve joint function, but in oncological surgery, disarticulation is favored.
The first step is ligating the supplying artery and vein, to prevent hemorrhage. The muscles are transsected, and finally the bone is sawed through with an oscillating saw. Skin and muscle flaps are then transposed over the stump, occasionally with the insertion of elements to attach a prosthesis. In a disarticulation amputation, the bone is removed at the joint.
Phantom limb is a phantom sensation in amputated or missing limbs. A phantom sensation is a feeling that a missing limb is still attached to the body and is moving appropriately with other body parts. Approximately 50 to 80% of amputees experience these phantom sensations in their amputated limb. Phantom sensations and phantom pain may also occur after the removal of body parts other than the limbs, e.g. after amputation of the breast, extraction of a tooth (phantom tooth pain) or removal of an eye (phantom eye syndrome).
Phantom pains can also occur in people who are born without limbs and people who are paralyzed. Phantom pains occur when the missing limb causes discomfort. Some other sensations include warmth, cold, itching, squeezing and burning. The missing limb often feels shorter and may feel as if it is in a distorted and painful position. Occasionally, the pain can be made worse by stress, anxiety and weather changes.
Some treatments include drugs such as antidepressants. Spinal cord stimulation (SCS) can be a very effective treatment for phantom pain. An electrical stimulator is implanted under the skin, and an electrode is placed next to the spinal cord. The nerve pathways in the spinal cord are stimulated by an electric current. This interferes with the impulses travelling towards the brain and lessens the pain felt in the phantom limb. Instead, amputees feel a tingling sensation in the phantom limb.
Vibration therapy, acupuncture, hypnosis and biofeedback may all be used to treat phantom pain but are often of little help. The pain can sometimes be helped by keeping busy and occupying your mind. Massaging the stump can sometimes help. The pain can often be prevented by the application of not only a general but also a local anaesthesia while amputating a limb.
In many cases, the phantom limb aids in adaptation to a prosthesis, as it permits the person to experience proprioception of the prosthetic limb.
Another side-effect can be heterotopic ossification, especially when a bone injury is combined with a head injury. The brain signals the bone to grow instead of scar tissue to form, and nodules and other growth can interfere with prosthetics and sometimes require further operations. This type of injury has been especially common among soldiers wounded by IEDs in the occupation of Iraq.
Source: Wikipedia » Amputation & Phantom Limb
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