Types of amputation

Of course, in the broadest sense of the term, all amputations are traumatic. However, the category ‘traumatic amputation’ refers to the way in which the amputation has occurred i.e. it is a sudden, violent and unexpected event that causes the loss of a person’s limbs.

There are innumerable ways in which an amputation can occur; ranging from high-risk situations where people are knowingly in positions of considerable danger, through to unfortunate and randomly occurring ‘freak-accidents’.

Some examples of the ways in which a traumatic amputation can happen include the following:

There are innumerable ways in which an amputation can occur; ranging from high-risk situations where people are knowingly in positions of considerable danger, through to unfortunate and randomly occurring ‘freak-accidents’.

Some examples of the ways in which a traumatic amputation can happen include the following:

  • Accidents involving machinery, often in the workplace
  • Road traffic accidents
  • Explosions or other blast injuries
  • Electric shocks
  • Becoming trapped in building or car doors

A traumatic amputation is an incredibly dangerous and often life-threatening situation, particularly through the loss of blood, but due to the advances in medical science during the last century, the prospects of survival have increased considerably. Treatment is usually quick to arrive at the scene of an accident, and efficient transferral to hospitals is possible by both road and air.

In traumatic amputations where a limb cannot be re-attached, the injured person—or amputee—will most likely undergo surgery to shape the bone in the remaining limb, to clean the wound (also known as debridement), and to close it. This may involve skin grafts, and could require more than one surgical procedure.

Surgical amputation

Surgical amputations have been a vital practice in medicine for thousands of years. They were once the main duty performed by surgeons, although the frequency of this has since diminished as medicine has advanced.

The most common reason for amputation in the UK is through complications with the blood vessels. In particular, this is when the blood’s supply to the limb has been lost and causes an extremely debilitating symptom called ‘necrosis’, which is when cells within living tissue die prematurely.

A surgical amputation can be necessary after a person has suffered from a traumatic injury, and they can be carried out as part of the immediate emergency treatment to save the person’s life or because their bones, tissuestissues—or both—have been so badly damaged that they cannot later be reconstructed. However, surgical amputation is usually considered to be a last resort, and if it is believed that a limb can be saved, surgeons will first try to do so.

For example, it could be that an injury sustained was only strong enough to remove a limb partially and therefore in the first instance it would be surgically reattached. In some complete traumatic amputation cases, surgeons can even attempt to reattach a previously severed but preserved limb via a method called ‘replantation surgery’. Such treatments are often very successful but, unfortunately, that may not always be the case.

It could be possible that a matter of weeks or months after the initial injury, it may become clear that a limb has lost its full and useful function, or that the person is now enduring insufferable pain. Following which, a decision could be made to amputate.

Some surgical amputations are even carried out many years after the initial injury. As an example, a person may have initially undergone major joint reconstruction. As their condition deteriorates over time a joint replacement may become necessary, but due to their injuries, the limb has been weakened and therefore unable to withstand further surgery, making surgical amputation the only option.

Once surgical amputation is underway, the medical team will aim to save as much of the injured limb as possible so that they can maximise the degree of function, which could include the future use of prosthetics.

Areas of amputation

An amputation can happen to any of the body’s limbs and extremities, be it the upper or lower half of the body. How the specific amputation is categorised is defined by the part of the body that is removed.

Read on for the different categories of amputation, and please note that the terms here apply to both traumatic and surgical amputations.

Upper-limb amputation – refers to the arms, hands or fingers and can be categorised as follows:

  • Shoulder disarticulation – this is the removal of the entire arm at shoulder level, and specifically, is an amputation through the shoulder itself.
  • Forequarter amputation – similar to shoulder disarticulation, a forequarter amputation is also the removal of an entire arm at the shoulder. However, it also includes the removal of the shoulder itself, as well as part of the shoulder blade and the collarbone.
  • Trans-humeral amputation (above the elbow) – these are amputations of the upper arm between the shoulder and the elbow, where the person retains use of their shoulder.
  • Elbow disarticulation – an amputation through the elbow joint itself.
  • Transradial amputation (below the elbow) – this is an amputation through the forearm i.e. between the elbow and hand, where use of the elbow is preserved.
  • Wrist disarticulation – these are amputations through the wrist joint itself.
  • Metacarpal amputation – an amputation of the hand where the wrist is left intact. This category of amputation can also take the form of partial hand amputation, where only part of the hand is removed, thus keeping the wrist in use.
  • Digit amputation – this is the amputation of one (or more) of the fingers or the thumb. It can be the entire digit, or its upper part or ‘tip’.

Lower-limb amputation – refers to amputations of the legs, feet or toes and can take the form of the following:

  • Pelvic or transpelvic amputation (also known as hemipelvectomy) – this is a rare form of lower-extremity amputation, involving the removal of up to half of the pelvis and the entire leg on that side. Hemipelvectomies can be further broken down into two sub-categories
    1. Internal – this is where a part of the pelvis is removed but the leg is saved.
    2. External – this is where the leg cannot be saved when part of the pelvis is removed.
  • Hip disarticulation – amputations of the entire leg through the hip joint capsule.
  • Transfemoral amputation (above the knee) – an amputation that occurs between the hip and the knee (through the thighbone), where the person retains full use of the hip joint.
  • Knee disarticulation – these are amputations through the knee joint itself.
  • Transtibial amputation (below the knee) – this is an amputation that occurs between the knee and the foot, preserving use of the knee. They are statistically the most common form of amputation in the U.K.
  • Ankle disarticulation – these are amputations through the ankle joint itself, removing the foot but otherwise preserving the leg.
  • Partial foot amputation – amputations where part of the foot is removed.
  • Digit amputation – these are amputations of one or more toes. It can be the removal of the entire toe, or a partial amputation such as the ‘tip’.

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