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Wednesday, June 19, 2013
Amputation of a body part is a "life-changing event." Body image, mood, mobility, ability to care for one's self, work, and non-work-related activities are all affected. Many issues arise following the loss of all or part of a person's limb(s); however, the long-term outcomes for amputees continue to improve.
Although over 90% of limb loss is "acquired", up to 4% is congenital (present at birth). Of the roughly 185,000 amputation surgeries performed each year in the United States,
While over 90% of amputations caused by vascular disease involve the lower limb, nearly 70% of amputations caused by trauma involve the upper limb. (Further statistics are available from resources such as the Amputee Coalition of America's National Limb Loss Information Center (NLLIC).)
Ideally, the need for an amputation can be lessened by:
Techniques used by vascular surgeons try to reduce the need for amputation byinclude:
Amputation surgery is only performed after a decision has been made that a person's overall level of function and quality of life will improve - rather than diminish - after amputation surgery and subsequent rehabilitation.
Visit Leg Artery Disease (Society for Vascular Surgery) for more information about these procedures.
In most, but not all, cases, a prosthesis (artificial limb) will enhance an amputee's mobility and self-care activities. A prosthesis should be comfortable, functional, and cosmetic. Training by a skilled physical and/or occupational therapist is necessary before and after receiving a prosthesis. This training will help to maximize functional use of the artificial limb. It will also prevent development of "bad habits" that may be difficult to break later.
Advances in medical treatments and surgical techniques continue. However, over the past 10 years, improved outcomes following amputation have largely been the result of advances in prosthetic technology. Consider the following examples.
For lower limb amputees:
The number of prosthetic feet that provide "dynamic response" and the ability to maneuver on uneven surfaces continues to increase. Also, at least one microprocessor-controlled prosthetic foot-ankle unit is now available.
For above-knee amputees:
There are currently at least 5 different prosthetic knee units that use "microprocessor-control." These units allow for more normal knee motion and stability through computerized parts that monitor motions and forces and make extremely rapid real-time adjustments while walking. This results in improved walking ability, requiring less effort.
For upper limb amputees:
The original available body-powered (cable-controlled) prosthetic designs remain in common use, are the most durable, and continue to improve. Although using electrical signals from the muscles (myoelectric componentry) to control prostheses for the upper limb has been in use for over 40 years, this technology continues to advance, with associated further enhancements in function. To improve the ability of high-level (close to or through the shoulder) upper limb amputees to use a myoelectric prosthesis, in 2006 a surgical technique called “targeted reinnervation” was introduced, where motor and sensory nerves are transferred to improve motor control and sensory feedback during prosthetic use. The application of this technique is still in the early stages.
Although these ongoing developments are exciting and expand the available treatment options, the most advanced prosthetic device may not be the most appropriate in every case. Optimal prosthetic rehabilitation is best provided through a coordinated team approach. Team members include:
Additional team members often include:
Working together, these team members help the patient regain maximum function, independence, and quality of life.
This article is a NetWellness exclusive.
Last Reviewed: Nov 12, 2008
Brian L Bowyer, MD
Clinical Associate Professor
Physical Medicine & Rehabilitation
College of Medicine
The Ohio State University