Amputation

Amputation is the loss or removal of a body part such as a finger, toe, hand, foot, arm or leg by trauma, medical illness or surgery.

• As a surgical measure, it is used often to control pain or a disease process in the affected limb, such as malignancy or gangrene or the result of an accident. In some cases, it is carried out on individuals as a preventive surgery for such problems.
• A special case is that of congenenital amputation, a congenital disorder, where fetal limbs have been cut off by constrictive bands.
• In some countries, such as Afghanistan and Iran, amputation was proposed, was formerly used, or is currently used to punish people who committed crimes.
• Amputation has also been used as a tactic in war and acts of terrorism; it may also occur as a war injury.
• In some cultures, and religions, minor amputations or mutilations are considered a ritual accomplishment. When done by a person, the person executing the amputation is an amputator

In the US, the majority of new amputations occur due to complications of the vascular system (the blood vessels), especially from diabetes. Between 1988 and 1996, there were an average of 133,735 hospital discharges for amputation per year in the US.[10] In 2005, just in the US, there were 1.6 million amputees.[11] In 2013, the US had 2.1 million amputees. Approximately 185,000 amputations occur in the United States each year. In 2009, hospital costs associated with amputation totaled more than $8.3 billion.[12] There will be an estimated 3.6 million people in the US living with limb loss by 2050.

Causes

• Circulatory disorders
  • Diabetic vasculopathy
  • Sepsis with peripheral necrosis
  • Peripheral artery disease which can lead to gangrene
  • A severe deep vein thrombosis (phlegmasia cerulea dolens) can cause compartment syndrome and gangrene
• Neoplasm
  • Cancerous bone or soft tissue tumors (e.g. osteosarcoma, chondrosarcoma, fibrosarcoma, epithelioid sarcoma, Ewing's sarcoma, synovial sarcoma, sacrococcygeal teratoma, liposarcoma), melanoma
• Trauma
  • Traumatic amputation is the partial or total avulsion of a part of a body during a serious accident, like traffic, labor, or combat.
  • Three fingers from a soldier's right hand were traumatically amputated during World War I.
  • Severe limb injuries in which the limb cannot be saved or efforts to save the limb fail.
  • Traumatic amputation (an unexpected amputation that occurs at the scene of an accident, where the limb is partially or entirely severed as a direct result of the accident, for example, a finger that is severed from the blade of a table saw)
  • Amputation in utero (Amniotic band)
• Congenital anomalies
  • Deformities of digits and/or limbs (e.g., proximal femoral focal deficiency, Fibular hemimelia)
  • Extra digits and/or limbs (e.g., polydactyly)
• Infection
  • Bone infection (osteomyelitis) and/or diabetic foot infections
  • Gangrene
  • Trench foot
  • Necrosis
  • Meningococcal meningitis
  • Streptococcus
  • Vibrio vulnificus
  • Necrotizing fasciitis
  • Gas gangrene
  • Legionella
  • Influenza A Virus
  • Animal bites
  • Sepsis
  • Bubonic plague
• Frostbite
  • Frostbite, also known as frostnip, happens when the individual's skin is exposed to cold weather for too long.
    • The fluid in the pale skin solidifies, creating ice crystals, leading to swelling and severe pain. Other symptoms can include numbness, confusion, dizziness, fatigue, nausea, stiffness in the muscles or joints as well as difficulty walking. If the frostbite doesn't get treated soon, this process results in hypothermia, death or poisoning of the bloodstream.
    • This can affect the hands, feet, toes, fingers, eyes, and face. Once the frostbite shuts the eyelids, this is known as snow blindness. The only way to stop it from spreading is through skin grafts or amputation.
• Athletic performance
  • Sometimes professional athletes may choose to have a non-essential digit amputated to relieve chronic pain and impaired performance.
    • Australian Rules footballer Daniel Chick elected to have his left ring finger amputated as chronic pain and injury was limiting his performance.
    • Rigby union player Jone Tawake also had a finger removed.
    • National Football league safety Ronnie Lott had the tip of his little finger removed after it was damaged in the 1985 NFL season.
• Criminal penalty
  • According to Quran 5.38, the punishment for stealing is the amputation of the hand. Under Sharia law, after repeated offense, the foot may also be cut off. This is still in practice today in countries like Iran (since the Islamic Revolution in 1979), Saudi Arabia, and 11 states of Northern Nigeria (since 1999, and only applied on Muslim people).
  • The United States considers amputation to be more severe than other punishments but less than death penalty, expressed in the double jeopardy clause: "nor shall any person be subject for the same offence to be twice put in jeopardy of life or limb...". Thomas Jefferson proposed a bill penalizing various crimes with amputation, such as "if a man, by castration, if a woman, by cutting thro' the cartilage of her nose a hole of one half inch diameter at the least" and "cutting out or disabling the tongue, slitting or cutting off a nose, lip or ear, branding, or otherwise, shall be maimed or disfigured in like sort: or if that cannot be for want of the same part, then as nearly as may be in some other part of at least equal value and estimation in the opinion of a jury". That bill is not a current law, so it either did not gain enough approval to become law, or it has since been repealed.
  • As of 2021, this form of punishment is controversial, as most modern cultures consider it to be morally abhorrent, as it has the effect of permanently disabling a person and constitutes torture. It is thus seen as a grossly disproportional for crimes less than those such as murder.

Epidemiology:

• In the United States in 1999, there were 14,420 non-fatal traumatic amputations according to the American Statistical Association. Of these, 4,435 occurred as a result of traffic and transportation accidents and 9,985 were due to labor accidents. Of all traumatic amputations, the distribution percentage is 30.75% for traffic accidents and 69.24% for labor accidents..
• The population of the United States in 1999 was about 300,000,000, so the conclusion is that there is one amputation per 20,804 persons per year. In the group of labor amputations, 53% occurred in laborers and technicians, 30% in production and service workers, 16% in silviculture and fishery workers.
• A study found that in 2010, 22.8% of patients undergoing amputation of a lower extremity in the United States were readmitted to the hospital within 30 days.[39]

Notables

1. Ranker - 54 Famous Amputees, updated 9/23/2021
2. Disabled World - List of Famous Amputees. Updated 5/2/2020
3. Famous People with Amputations

• Olivia Jackson (1983-present) – South African stunt performer & actress (Left arm due to motorcycle crash)
• Heaher Mills(1968-present) – Philanthropist (lost leg below knee in traffic accident)
• Jerry Garcia (1942-1995) – Grateful Dead musician (finger lost due to wood chopping accident)
• Bethany Hamilton (1990-present) – Surfer (Left arm bitten off in shark attack); (Bethany Hamilton -Wikipedia)
• Ella Fitzgerald (1917-1996) – Musician. (both legs due to complications with diabetes)
• Zsa Zsa Gábor (1917-2016) - Actress (Right leg due to infection)
• Oscar Pistorious (1986-present) – Olympian (both legs as a infant due to fibular hemimelia)
• [ Cole Porter Cole Porter] (1891-1964) – Musician (Right leg due to injuries & ulcers
• Sarah Bernhardt (1844-1923) – French actress (leg after it became infected with gangrene due to poorly performed stunt 10 years before)
• [ Frida Kahlo Frida Kahlo] (1907-1954) – Painter – (Right leg due to gangrene)
• George Louis Eyser (1870- March 6, 1919) German/American gymnast – (Right leg due to being run over by a train)
• Edward (Ted) Kennedy, Jr (1961-present) – American lawyer & politician (Right leg due to bone cancer)

Resources & additional reading:

• Wikipedia - Amputation
• Musculoskeletal Key – Ideal Functional Outcome for Amputation Levels
• WebMD - Amputation Overview
• MedlinePlus - Limb Loss
• Johns Hopkins Medicine – Amputation; by: Jaimie Troyal Shores, MD
• Society for Vascular Surgery – Amputation; by: Dr Kathleen Lamb