Amputation is the surgical removal of all or part of a limb or extremity such as an arm, leg, foot, hand, toe, or finger. About 1.8 million Americans are living with amputations. Amputation of the leg either above or below the knee is the most common amputation surgery, removal of a limb by trauma, medical illness, 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 preventive surgery for such problems. A special case is that of congenital amputation, a congenital disorder, where fetal limbs have been cut off by constrictive bands. In some countries, amputation of the hands, feet or other body parts is or was used as a form of punishment for people who committed crimes.

There are many reasons an amputation may be necessary. The most common is poor circulation because of damage or narrowing of the arteries, called peripheral arterial disease. Without adequate blood flow, the body's cells cannot get oxygen and nutrients they need from the bloodstream. As a result, the affected tissue begins to die and infection may set in. When performing an amputation, surgeons generally cut above the diseased or injured area so that a portion of healthy tissue remains to cushion bone. Sometimes the location of a cut may depend in part on its suitability to be fitted with an artificial limb, or prosthesis.

Other causes for amputation may include: Severe injury (from a vehicle accident or serious burn, for example), Cancerous tumor in the bone or muscle of the limb, Serious infection that does not get better with antibiotics or other treatment, Thickening of nerve tissue, called a neuroma, Frostbite.

Initially, the arterial and venous supply is ligated to prevent hemorrhage (bleeding). The muscles are transected and the bone is sawed through with an oscillating saw. Sharp and rough edges of the bone are filed down; skin and muscle flaps are then transposed over the stump.

Distal stabilisation of the muscles is recommended, allowing for effective muscle contraction and reduced atrophy. This in turn allows for a greater functional use of the stump and maintains soft tissue coverage of the remnant bone. Muscles should be attached under similar tension to normal physiological conditions. myodesis: the muscles and fascia are sutered directly to the distal residual bone for better prosthetic control. myoplastic: suture to opposite muscle in the residual limb to to each other and to the periosteum or to the distal end of the cut bone for weight bearing purposes.

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Journal of Physiotherapy and Rehabilitation

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