Amputation

Amputation involves the removal of an extremity of the body, usually the leg, foot, toe, arm, hand, or finger. The removal may occur through surgery, trauma, prolonged constriction, or by the individual (self-amputation). Amputation may arise from diabetes-related complications, a traumatic injury (e.g., a vehicular accident), or other disease-related developments, (e.g., peripheral vascular disease, or PVD, which is the hardening of the arteries, and cancerous tumors). A number of amputations may also be congenital, meaning the limb loss is present at birth. There are approximately 2 million persons in the United States (about one in every 200 persons) with some form of limb loss. In fact, about 185,000 amputations take place annually at high financial and often high emotional costs to each individual.

However, especially since the start of Operation Enduring Freedom in Afghanistan in 2001, the concept of the amputee as an incomplete body is slowly being rewritten to one that is sacrificial, heroic, and valued because of the increased presence of injured war veterans. The implications of redefining the identity of the amputee are significant for the individual, the patient's family, and society. Health communication scholars may situate amputation in the larger discourse on [Page 74]disability and the body. Scholars are challenged to explore how language is used to (re)assign meaning to the body and to (dis)place the (dis)abled body in society.

Several circumstances necessitate an amputation. Persons with Type 1 and Type 2 diabetes mellitus account for over two-thirds of the lower extremity amputations (LEA) conducted in the United States. In fact, diabetes-related amputations account for a majority of the total number of limb loss hospital discharges, with the average age of patients being 66 years. In order of descending occurrence, the LEA rate is highest for toe amputations, followed by below-knee amputations, foot amputations and, finally, above-the-knee amputations. Peripheral neuropathy (disease of the nerves) and complications of the vascular system, such as poor blood circulation and PVD, are the most common causes of LEA occurrence among persons with diabetes. The rate of LEA among persons with diabetes is decreasing, though, as health care improves. Only partial toe amputations, which have very little effect on the quality of life, are increasing. However, males and African Americans still remain at the highest risk.

An instructor from the Coronado Surfing Academy in San Diego, California, teaches basic skills to amputee participants and physical therapists from the Military Amputee Advanced Skills Training workshop, July 30, 2009. Because of the increased presence of injured war veterans, the concept of the amputee as an incomplete body is gradually shifting to one that is sacrificial, heroic, and valued.

Other disease-related developments are also responsible for limb loss; however, these are decreasing in rate, with the average age of patients being 71 years. Specifically, cancer-related amputations are commonly of the lower extremities, with above-knee and below-knee amputations accounting for a majority of the loss (about 36 percent) in this group. African Americans have the highest number of cancer-related limb losses, mostly due to a lack of access to primary and specialty care to monitor their illness. In other [Page 75]instances, chronic or acute infections resistant to antibiotics may necessitate an amputation. In fact, smoking may also lead to PVD, which can cause a gangrenous infection that must be removed by amputation.

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