Traumatic amputations

Encyclopedia of Medicine, Apr 06, 2001 by Maureen Haggerty

Traumatic amputation is the accidental severing of some or all of a body part. A complete amputation totally detaches a limb or appendage from the rest of the body. In a partial amputation, some soft tissue remains attached to the site.

Trauma is the second leading cause of amputation in the United States. About 30,000 traumatic amputations occur in this country every year. Four of every five traumatic amputation victims are male, and most of them are between the ages of 15-30.

Traumatic amputation most often affects limbs and appendages like the arms, ears, feet, fingers, hands, legs, and nose.

Farm and factory workers have greater-than-average risks of suffering injuries that result in traumatic amputation. Automobile and motorcycle accidents and the use of lawnmowers, saws, and power tools are also common causes of traumatic amputation.

Blood loss may be massive or minimal, depending on the nature of the injury and the site of the amputation. Patients who lose little blood and have less severe injuries sometimes feel more pain than patients who bleed heavily and whose injuries are life-threatening.

When the patient and the amputated part(s) reach the hospital, an Emergency Department physician will assess the probability that the severed tissue can be successfully reattached.

The Mangled Extremity Severity Score (MESS) assigns numerical values to such factors as body temperature, circulation, numbness, paralysis, tissue health, and the patient's age and general health. This is one of the diagnostic tools used to determine how successful reattachment surgery is apt to be. The total score is doubled if blood supply to the amputated part has been absent or diminished for more than six hours.

A general, emergency, or orthopedic surgeon makes the final determination about whether surgery should be performed. The surgeon also considers the patient's wishes and lifestyle. Additional concerns are how and to what extent the amputation will affect the patient's quality of life and ability to perform everyday activities.

First aid or emergency care given immediately after the amputation has a critical impact on both the physicians' ability to salvage and reattach the severed part(s) and the patient's ability to regain feeling and function.

Muscle tissue dies quickly, but a well-preserved part can be successfully reattached as much as 24 hours after the amputation occurs. Tissue that has not been preserved will not survive for more than six hours.

The most important steps to take when a traumatic amputation occurs are:

• Contact the nearest emergency services provider, clearly describe what has happened, and follow any instructions given.
• Make sure the victim can breathe; administer CPR if necessary.
• Control bleeding, using direct pressure but minimizing or avoiding contact with blood and other body fluids.
• Patients should not be moved if back, head, leg, or neck injuries are suspected or if motion causes pain. If none are found by the EMT, lie the victim flat, with the feet raised 12 inches above the surface.
• Cover the victim with a coat or blanket to prevent shock.

The injured site should be cleansed with a sterile solution and wrapped in a clean towel or other thick material that will protect the wound from further injury. Tissue that is still attached to the body should not be forced back into place. If it cannot be gently replaced, it should be held in its normal position and supported until additional care is available.

Saving the patient's life is always more important than recovering the amputated part(s). Transporting the patient to a hospital or emergency center should never be delayed until missing pieces are located.

No amputated body part is too small to be salvaged. Debris or other contaminating material should be removed, but the tissue should not be allowed to get wet.

An amputated body part should be wrapped in bandages, towels, or other clean, protective material and sealed in a plastic bag. Placing the sealed bag in a cooler or in a container that is inside a second container filled with cold water or ice will help prevent tissue deterioration.

Possible complications of traumatic amputation include:

• Excessive bleeding
• Infection
• Muscle shortening
• Pulmonary embolism.

Improved medical and surgical care and rehabilitation have improved the long-term outlook for these patients.

About 80% of all amputees over the age of four experience tingling, itching, numbness, or pain in the place where the amputated part used to be. Phantom sensations may begin immediately after the amputation, or they may develop months or years later. They often occur after an injury to the site of the amputation.

These intermittent feelings may:

• Occur frequently or only once in a while
• Be mild or intense
• Last for a few minutes or several hours
• Help patients adjust more readily to an artificial limb (prosthesis).

The best way to prevent traumatic amputation is to observe common-sense precautions like using seat belts and obeying speed limits and other traffic regulations. It is important to take special precautions when using potentially dangerous equipment and make sure machinery is turned off and disconnected before attempting to service or repair it. Appropriate protective clothing should be worn at all times.