The main causes of limb amputation are
Blood vessel (vascular) disease, particularly from diabetes Diabetes Mellitus (DM) Diabetes mellitus is a disorder in which the body does not produce enough or respond normally to insulin, causing blood sugar (glucose) levels to be abnormally high. Symptoms of diabetes may... read more or peripheral arterial disease Overview of Peripheral Arterial Disease Peripheral arterial disease results in reduced blood flow in the arteries of the trunk, arms, and legs. Most often, doctors use the term peripheral arterial disease to describe poor circulation... read more
Injury (for example, from a motor vehicle crash, work-related accident, or military combat)
In the United States, about 1 in 200 people are currently living with the loss of a limb, and about 500 amputations are done each day. This percentage is likely to increase because, as the population ages, more people will develop diabetes and vascular disease.
For people who have had an amputation, a prosthesis (artificial limb) is often recommended to replace that body part. At a minimum, a prosthesis should enable the person to perform daily activities (such as walking, eating, and dressing) independently and comfortably. At best, a prosthesis may enable the person to function as well or nearly as well as before the amputation.
Success with a prosthesis is most likely to occur when the clinical team involved has many different types of professionals, depending on the person’s needs. At a minimum, core team members include the surgeon, prosthetist, and physical therapist. Prosthetists are experts who evaluate the amputee's overall functional capabilities and develop a prosthesis treatment plan, which includes designing, fitting, fabricating, and adjusting the prosthesis and providing lifetime follow-up care to maintain the prosthesis and provide advice and instruction on care. For more complex cases, the team could also include a physiatrist, occupational therapist, social worker, psychologist, and family members.
People may have concerns regarding passing through airport security with a prosthesis. Security personnel typically do not ask people to remove a prosthesis. If they do, they are obligated to do this in a private setting, because it usually requires removing some clothing. It may be useful for the prosthetist to write a letter stating that the prosthesis has metallic and microprocessor components and that leaving the prosthesis off for more than 10 to 15 minutes could make it difficult to put it back on because the fluid volume of the stump will increase.
Goals range from simple mobility to being able to do high-impact activities, such as running and jumping. The prosthesis' components are customized to help people achieve their different goals. Advances in cushioning materials, prosthetic socket design, and foot, ankle, knee, hand, wrist, and elbow component technology have significantly improved comfort and function. When fitting a prosthesis Prosthesis Fitting There are many options for limb prostheses. However, the fitting process typically follows the same steps regardless of the options chosen. After the socket fits and functions well, people are... read more , the prosthetist works to make sure that the amputee is comfortable, stable while standing and walking, and able to or achieve individual goals.
Highly motivated, otherwise healthy people with a prosthesis can accomplish many extraordinary feats (for example, go skydiving, climb mountains, complete triathlons, fully participate in sports, or return to demanding jobs or to active duty in the military). Whether a prosthesis is used only for basic mobility or for more demanding activities, it can provide profound psychologic benefits and improve quality of life.
Successful prosthesis use depends on the following:
The person's other medical conditions
The person's physical and cognitive capabilities
The characteristics of the amputation stump
How well the prosthesis socket fits and connects to the body
Prosthesis fitting is a specialized skill. Also it can be hard for people to make the physical and mental adjustments necessary to function with the prosthesis. Thus, the whole process of selecting and adjusting components and assessing overall prosthesis function is challenging and takes significant time. Not all patients are candidates for all types of prosthesis.
An entire limb or part of one may be amputated. Doctors weigh many factors when amputating a limb. It is very important to
Remove dead or infected tissue
Ensure there is good blood flow in the residual limb (stump)
Other important considerations are to
Preserve muscles and their attachments to bones as much as possible
Cover the end of the stump with muscle
Preparing for an amputation
Having an amputation is difficult for people. Losing a limb is not only physically challenging, but people's self-image often changes after they lose a part of "themselves." Doctors and prosthetists try to prepare people and their family by explaining why an amputation is necessary and what will happen before and after the amputation and during the prosthesis fitting process. People who understand the process and have realistic expectations of the difficulties they may face and the most likely outcomes are more likely to persevere and have a better result. Doctors sometimes arrange for the person to talk with someone who already has an amputation and has adjusted well to it.
Before doing surgery, doctors try to get people in the best possible medical condition. They try to alleviate existing medical problems, such as poor nutrition, diabetes, and heart or lung disease as much as possible. Because smoking interferes with healing, smoking cessation Smoking Cessation Most people who smoke want to quit and have tried doing so with limited success. Effective tools to help quit smoking include counseling, nicotine replacement products, and medications. While... read more measures are important. If time permits, people who are weak or debilitated may do therapy and exercises to make them stronger and more flexible.
Immediately after surgery, the medical team starts measures to
Maintain range of motion of joints to prevent them from becoming stiff
Maintain or increase people's strength and general conditioning
Manage swelling (edema) in the stump
When recovery permits, people should begin to desensitize the end of their stump by massage, tapping, vibration, and starting to bear weight on it.
Prosthesis fitting Prosthesis Fitting There are many options for limb prostheses. However, the fitting process typically follows the same steps regardless of the options chosen. After the socket fits and functions well, people are... read more can begin when the surgical wound is sufficiently healed and the swelling has gone down enough, provided that the person has enough overall strength and joint range of motion. Prosthesis fitting usually occurs about 7 to 10 weeks after amputation.
The amputation stump continues to change for 6 to 18 months after amputation as more fluid leaves the stump and the muscles reshape. While these changes are ongoing, prosthetists may fit one or more temporary sockets until the amputation stump stabilizes. When the amputation stump seems close to its final size and shape, prosthetists fit the person with a definitive prosthesis. A temporary prosthesis allows people to become accustomed to pressures and forces involved in using a prosthesis.
Early rehabilitation facilitates recovery and future success in using a prosthesis. When possible for people whose amputation is scheduled, rehabilitation begins before the amputation. For people whose amputation is done suddenly (for example, because of injury sustained in a motor vehicle crash or combat), rehabilitation is begun as early as the first day after surgery. (See also Rehabilitation After Limb Amputation Rehabilitation After Limb Amputation Before surgery, a surgeon, prosthetist, and physical therapist discuss plans and goals with the person who requires amputation. A prosthetist is an expert who fits, builds, and adjusts artificial... read more .)
Complications after amputation
Complications may include persistent pain in the residual limb Residual Limb Pain After an amputation, over 70% of people have pain in the residual limb (stump), which can severely limit function, impair quality of life, and significantly impede rehabilitation. Residual-limb... read more , delayed healing often due to poor circulation, skin breakdown Skin breakdown Skin that comes in contact with the socket of the prosthesis must be cared for and carefully checked to prevent skin breakdown and skin infection. Skin breakdown is when the skin is damaged... read more , skin infection Skin infection Skin that comes in contact with the socket of the prosthesis must be cared for and carefully checked to prevent skin breakdown and skin infection. Skin breakdown is when the skin is damaged... read more , and swelling of the residual limb Residual Limb Swelling Even after the residual limb (stump) matures 18 to 24 months after surgery, swelling can still occur. Having a well-fitting prosthesis socket is the best way to maintain a consistent residual-limb... read more . These may be due to a problem with the residual limb or with the prosthesis and/or socket.
More Information about Limb Prosthetics
The following English-language resources may be useful. Please note that The Manual is not responsible for the content of these resources.
Amputee Coalition: Information to promote limb loss prevention and provide education, support, and advocacy for people affected by limb loss
U.S. Department of Veterans Affairs: Rehabilitation and Prosthetic Services: Resources regarding national policies and programs for medical rehabilitation and prosthetic and sensory aids services that promote the health, independence and quality of life for Veterans with disabilities