Amputees

Amputation is an acquired condition that results in the loss of a limb, usually from injury, disease, 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. Arms, legs, hands, feet, fingers, and toes can all be amputated. Congenital (present at birth) limb deficiency occurs when an infant is born without part or all of a limb. The causes of congenital limb differences are frequently unknown, but might be attributed to drug use in the mother.

In the United States, 185,000 amputations are performed each year, with the highest rates among people aged 65 and older.

About 1.2 million individuals in the United States are living with an amputation, with 185,000 performed each year. The birth prevalence of congenital limb deficiency is around 25 per 100,000 live births. The prevalence rate is highest among people aged 65 years and older, around 19.4 per 1,000. The number of total amputees worldwide is not currently known.

The causes of amputation differ significantly in various countries. For example, countries with a recent history of warfare and civil unrest might have a higher incidence of amputations due to war itself or [Page 126]its technology (landmines, uncontrolled ordnance, etc.). In Islamic countries, amputation of the hands or feet is sometimes used as a form of punishment for criminals. In some cultures and religions, minor amputations or mutilations are considered a ritual accomplishment. The avulsion of some teeth (mainly incisives) is or was practiced by some cultures for ritual purposes (e.g., in the Iberomaurusian culture of Neolithic north Africa). Genital modification and mutilation may involve amputating tissue (as is the case with circumcision), although not necessarily as a result of injury or disease.

In the United States, the most common causes of amputation of the lower extremity are disease (70 percent), trauma (22 percent), congenital or birth defects (4 percent), and tumors (4 percent). As for upper extremity amputation, it is usually performed because of trauma or birth defect. Common traumas that lead to amputation of the limbs include industrial accidents and burns. Among the diseases and conditions that may lead to amputation of an extremity, the most prevalent are hardening of the arteries, arterial embolism, impaired circulation as a complication of diabetes mellitus, gangrene, and severe frostbite.

Amputations can be either planned or emergency procedures. The operation is performed under regional or general anesthesia by a general or orthopedic surgeon in a hospital operating room. All amputations consist of a twofold surgical procedure: to remove diseased tissue so that the wound will heal cleanly and to construct a stump that will allow the attachment of a prosthesis or artificial replacement part.

After amputation, medication is prescribed for pain, and patients are treated with antibiotics to discourage infection. Physical therapy and rehabilitation are started as soon as possible, usually within 48 hours. Rehabilitation is a long, arduous process. In addition, many people feel a sense of loss and grief when they lose a body part. A large proportion of amputees (50 to 80 percent) experience the phenomenon of phantom limbs; they feel body parts that are no longer there.

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