Amputation

Last updated
Amputation
Other namesSevered limb
Flickr - The U.S. Army - U.S. Army World Class Athlete Program Paralympic.jpg
An amputee running with a blade prosthetic
Specialty Surgery

Physical medicine and rehabilitation

Emergency medicine
Complications Phantom limb syndrome
Causes Trauma or intentional as part of surgery and sometimes corporal punishment.

Amputation is the removal of a limb by trauma, medical illness, 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. In some cases, it is carried out on individuals as a preventive surgery for such problems. A special case is that of congenital amputation, a congenital disorder, where fetal limbs have been cut off by constrictive bands. In some countries, judicial amputation is currently used to punish people who commit crimes. [1] [2] [3] [4] 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. [5] [6] [7] When done by a person, the person executing the amputation is an amputator. [8] [9] The oldest evidence of this practice comes from a skeleton found buried in Liang Tebo cave, East Kalimantan, Indonesian Borneo dating back to at least 31,000 years ago, where it was done when the amputee was a young child. [10]

Contents

Types

Leg

Lower limb amputations can be divided into two broad categories: minor and major amputations. Minor amputations generally refer to the amputation of digits. Major amputations are commonly below-knee- or above-knee amputations. Common partial foot amputations include the Chopart, Lisfranc, and ray amputations.

Common forms of ankle disarticulations include Pyrogoff, Boyd, and Syme amputations. [11] A less common major amputation is the Van Nes rotation, or rotationplasty, i.e. the turning around and reattachment of the foot to allow the ankle joint to take over the function of the knee.

Types of amputations include:

An above-knee amputation Diagram showing an above knee amputation CRUK 094.svg
An above-knee amputation
partial foot amputation
amputation of the lower limb distal to the ankle joint
ankle disarticulation
amputation of the lower limb at the ankle joint
trans-tibial amputation
amputation of the lower limb between the knee joint and the ankle joint, commonly referred to as a below-knee amputation
knee disarticulation
amputation of the lower limb at the knee joint
trans-femoral amputation
amputation of the lower limb between the hip joint and the knee joint, commonly referred to an above-knee amputation
hip disarticulation
amputation of the lower limb at the hip joint
trans-pelvic disarticulation
amputation of the whole lower limb together with all or part of the pelvis, also known as a hemipelvectomy or hindquarter amputation

Arm

The 18th century guide to amputations Amputations 18c.jpg
The 18th century guide to amputations

Types of upper extremity amputations include:

A variant of the trans-radial amputation is the Krukenberg procedure in which the radius and ulna are used to create a stump capable of a pincer action.

Other

Partial amputation of index finger. Index finger amputation.jpg
Partial amputation of index finger.

Hemicorporectomy, or amputation at the waist, and decapitation, or amputation at the neck, are the most radical amputations.

Genital modification and mutilation may involve amputating tissue, although not necessarily as a result of injury or disease.

Self-amputation

In some rare cases when a person has become trapped in a deserted place, with no means of communication or hope of rescue, the victim has amputated their own limb. The most notable case of this is Aron Ralston, a hiker who amputated his own right forearm after it was pinned by a boulder in a hiking accident and he was unable to free himself for over five days. [12]

Body integrity identity disorder is a psychological condition in which an individual feels compelled to remove one or more of their body parts, usually a limb. In some cases, that individual may take drastic measures to remove the offending appendages, either by causing irreparable damage to the limb so that medical intervention cannot save the limb, or by causing the limb to be severed. [13]

Urgent

In surgery, a guillotine amputation is an amputation performed without closure of the skin in an urgent setting. [14] Typical indications include catastrophic trauma or infection control in the setting of infected gangrene. [14] A guillotine amputation is typically followed with a more time-consuming, definitive amputation such as an above or below knee amputation. [14]

Causes

Circulatory disorders

Neoplasm

Transfemoral amputation due to liposarcoma 1daypost.jpg
Transfemoral amputation due to liposarcoma

Trauma

Three fingers from a soldier's right hand were traumatically amputated during World War I. World War I radiography amputee.jpg
Three fingers from a soldier's right hand were traumatically amputated during World War I.

Congenital anomalies

Infection

Frostbite

Frostbite is a cold-related injury occurring when an area (typically a limb or other extremity) [17] is exposed to extreme low temperatures, causing the freezing of the skin or other tissues. [18] Its pathophysiology involves the formation of ice crystals upon freezing and blood clots upon thawing, leading to cell damage and cell death. [18] Treatment of severe frostbite may require surgical amputation of the affected tissue or limb; [19] if there is deep injury autoamputation may occur. [20]

Athletic performance

Sometimes professional athletes may choose to have a non-essential digit amputated to relieve chronic pain and impaired performance.

Criminal penalties

Surgery

Method

Curved knives such as this one were used, in the past, for some kinds of amputations. Curvy amputation knife DSC09451.jpg
Curved knives such as this one were used, in the past, for some kinds of amputations.

Surgeons performing an amputation have to first ligate the supplying artery and vein, so as to prevent hemorrhage (bleeding). The muscles are transected, and finally, the bone is sawed through with an oscillating saw. Sharp and rough edges of bones are filed, skin and muscle flaps are then transposed over the stump, occasionally with the insertion of elements to attach a prosthesis.

Amputation of the leg of First Lieutenant Antonio Carlos de Mariz e Barros, commander of the Brazilian Battleship Tamandare (Henrique Fleiuss, Semana Illustrada, 1866). Ultimos momentos do heroico 1o tenente - Mariz e Barros - commandante do encouracado - Tamandare. -.jpg
Amputation of the leg of First Lieutenant Antônio Carlos de Mariz e Barros, commander of the Brazilian Battleship Tamandaré (Henrique Fleiuss, Semana Illustrada, 1866).

Distal stabilisation of muscles is often performed. This allows effective muscle contraction which reduces atrophy, allows functional use of the stump and maintains soft tissue coverage of the remnant bone. The preferred stabilisation technique is myodesis where the muscle is attached to the bone or its periosteum. In joint disarticulation amputations tenodesis may be used where the muscle tendon is attached to the bone. Muscles are attached under similar tension to normal physiological conditions. [48]

An experimental technique known as the "Ewing amputation" aims to improve post-amputation proprioception. [49] [50] Another technique with similar goals, which has been tested in a clinical trial, [51] is Agonist-antagonist Myoneural Interface (AMI). [52]

In 1920,  Dr. Janos Ertl Sr. of Hungary, developed the Ertl procedure in order to return a high number of amputees to the work force. [53] The Ertl technique, an osteomyoplastic procedure for transtibial amputation, can be used to create a highly functional residual limb. Creation of a tibiofibular bone bridge provides a stable, broad tibiofibular articulation that may be capable of some distal weight bearing. Several different modified techniques and fibular bridge fixation methods have been used; however, no current evidence exists regarding comparison of the different techniques. [54]

Post-operative management

A 2019 Cochrane systematic review aimed to determine whether rigid dressings were more effective than soft dressings in helping wounds heal following transtibial (below the knee) amputations. Due to the limited and very low certainty evidence available, the authors concluded that it was uncertain what the benefits and harms were for each dressing type. They recommended that clinicians consider the pros and cons of each dressing type on a case-by-case basis: rigid dressings may potentially benefit patients who have a high risk of falls; soft dressings may potentially benefit patients who have poor skin integrity. [55]

A 2017 review found that the use of rigid removable dressings (RRD's) in trans-tibial amputations, rather than soft bandaging, improved healing time, reduced edema, prevented knee flexion contractures and reduced complications, including further amputation, from external trauma such as falls onto the stump. [56]

Post-operative management, in addition to wound healing, considers maintenance of limb strength, joint range, edema management, preservation of the intact limb (if applicable) and stump desensitization.

Trauma

Traumatic amputation is the partial or total avulsion of a part of a body during a serious accident, like traffic, labor, or combat. [57] [58]

Traumatic amputation of a human limb, either partial or total, creates the immediate danger of death from blood loss. [59]

Orthopedic surgeons often assess the severity of different injuries using the Mangled Extremity Severity Score. Given different clinical and situational factors, they can predict the likelihood of amputation. This is especially useful for emergency physicians to quickly evaluate patients and decide on consultations. [60]

Causes

Private Lewis Francis was wounded July 21, 1861, at the First Battle of Bull Run by a bayonet to the knee. 3372709503 10dc75d783 oSequelleAmputation.jpg
Private Lewis Francis was wounded July 21, 1861, at the First Battle of Bull Run by a bayonet to the knee.

Traumatic amputation is uncommon in humans (1 per 20,804 population per year). Loss of limb usually happens immediately during the accident, but sometimes a few days later after medical complications. Statistically, the most common causes of traumatic amputations are: [61]

Treatment

The development of the science of microsurgery over the last 40 years has provided several treatment options for a traumatic amputation, depending on the patient's specific trauma and clinical situation:[ citation needed ]

Epidemiology

Prevention

Methods in preventing amputation, limb-sparing techniques, depend on the problems that might cause amputations to be necessary. Chronic infections, often caused by diabetes or decubitus ulcers in bedridden patients, are common causes of infections that lead to gangrene, which, when widespread, necessitates amputation. [67]

There are two key challenges: first, many patients have impaired circulation in their extremities, and second, they have difficulty curing infections in limbs with poor blood circulation. [68] [69]

Crush injuries where there is extensive tissue damage and poor circulation also benefit from hyperbaric oxygen therapy (HBOT). The high level of oxygenation and revascularization speed up recovery times and prevent infections. [70]

A study found that the patented method called Circulator Boot achieved significant results in prevention of amputation in patients with diabetes and arteriosclerosis. [71] [72] Another study found it also effective for healing limb ulcers caused by peripheral vascular disease. [73] The boot checks the heart rhythm and compresses the limb between heartbeats; the compression helps cure the wounds in the walls of veins and arteries, and helps to push the blood back to the heart. [74]

For victims of trauma, advances in microsurgery in the 1970s have made replantations of severed body parts possible.

The establishment of laws, rules, and guidelines, and employment of modern equipment help protect people from traumatic amputations. [75]

Prognosis

The individual may experience psychological trauma and emotional discomfort. The stump will remain an area of reduced mechanical stability. Limb loss can present significant or even drastic practical limitations. [76]

A large proportion of amputees (50–80%) experience the phenomenon of phantom limbs; [77] they feel body parts that are no longer there. These limbs can itch, ache, burn, feel tense, dry or wet, locked in or trapped or they can feel as if they are moving. Some scientists believe it has to do with a kind of neural map that the brain has of the body, which sends information to the rest of the brain about limbs regardless of their existence. Phantom sensations and phantom pain may also occur after the removal of body parts other than the limbs, e.g. after amputation of the breast, extraction of a tooth (phantom tooth pain) or removal of an eye (phantom eye syndrome).

A similar phenomenon is unexplained sensation in a body part unrelated to the amputated limb. It has been hypothesized that the portion of the brain responsible for processing stimulation from amputated limbs, being deprived of input, expands into the surrounding brain, ( Phantoms in the Brain : V.S. Ramachandran and Sandra Blakeslee) such that an individual who has had an arm amputated will experience unexplained pressure or movement on his face or head. [78]

In many cases, the phantom limb aids in adaptation to a prosthesis, as it permits the person to experience proprioception of the prosthetic limb. To support improved resistance or usability, comfort or healing, some type of stump socks may be worn instead of or as part of wearing a prosthesis. [76]

Another side effect can be heterotopic ossification, especially when a bone injury is combined with a head injury. The brain signals the bone to grow instead of scar tissue to form, and nodules and other growth can interfere with prosthetics and sometimes require further operations. This type of injury has been especially common among soldiers wounded by improvised explosive devices in the Iraq War. [79]

Due to technological advances in prosthetics, many amputees live active lives with little restriction. Organizations such as the Challenged Athletes Foundation have been developed to give amputees the opportunity to be involved in athletics and adaptive sports such as amputee soccer. [80]

Nearly half of the individuals who have an amputation due to vascular disease will die within 5 years, usually secondary to the extensive co-morbidities rather than due to direct consequences of amputation. This is higher than the five year mortality rates for breast cancer, colon cancer, and prostate cancer. [81] Of persons with diabetes who have a lower extremity amputation, up to 55% will require amputation of the second leg within two to three years. [82]

Etymology

The word amputation is borrowed from Latin amputātus, past participle of amputāre "to prune back (a plant), prune away, remove by cutting (unwanted parts or features), cut off (a branch, limb, body part)," from am-, assimilated variant of amb- "about, around" + putāre "to prune, make clean or tidy, scour (wool)". The English word "Poes" was first applied to surgery in the 17th century, possibly first in Peter Lowe's A discourse of the Whole Art of Chirurgerie (published in either 1597 or 1612); his work was derived from 16th-century French texts and early English writers also used the words "extirpation" (16th-century French texts tended to use extirper), "disarticulation", and "dismemberment" (from the Old French desmembrer and a more common term before the 17th century for limb loss or removal), or simply "cutting", but by the end of the 17th century "amputation" had come to dominate as the accepted medical term. [83]

Notable cases

See also

Related Research Articles

<span class="mw-page-title-main">Prosthesis</span> Artificial device that replaces a missing body part

In medicine, a prosthesis, or a prosthetic implant, is an artificial device that replaces a missing body part, which may be lost through physical trauma, disease, or a condition present at birth. Prostheses are intended to restore the normal functions of the missing body part. Amputee rehabilitation is primarily coordinated by a physiatrist as part of an inter-disciplinary team consisting of physiatrists, prosthetists, nurses, physical therapists, and occupational therapists. Prostheses can be created by hand or with computer-aided design (CAD), a software interface that helps creators design and analyze the creation with computer-generated 2-D and 3-D graphics as well as analysis and optimization tools.

<span class="mw-page-title-main">Compartment syndrome</span> Condition in which increased pressure results in insufficient blood supply

Compartment syndrome is a condition in which increased pressure within one of the body's anatomical compartments results in insufficient blood supply to tissue within that space. There are two main types: acute and chronic. Compartments of the leg or arm are most commonly involved.

<span class="mw-page-title-main">Gangrene</span> Type of tissue death by infection or lack of blood supply

Gangrene is a type of tissue death caused by a lack of blood supply. Symptoms may include a change in skin color to red or black, numbness, swelling, pain, skin breakdown, and coolness. The feet and hands are most commonly affected. If the gangrene is caused by an infectious agent, it may present with a fever or sepsis.

<span class="mw-page-title-main">Phantom limb</span> Sensation that an amputated or missing limb is attached

A phantom limb is the sensation that an amputated or missing limb is still attached. Approximately 80–100% of individuals with an amputation experience sensations in their amputated limb. However, only a small percentage will experience painful phantom limb sensation. These sensations are relatively common in amputees and usually resolve within two to three years without treatment. Research continues to explore the underlying mechanisms of phantom limb pain (PLP) and effective treatment options.

<span class="mw-page-title-main">Frostbite</span> Effect of low temperature on skin and other tissues

Frostbite is a skin injury that occurs when exposed to extremely low temperatures, causing the freezing of the skin or other tissues, commonly affecting the fingers, toes, nose, ears, cheeks and chin areas. Most often, frostbite occurs in the hands and feet. The initial symptoms are typically a feeling of cold and tingling or numbing. This may be followed by clumsiness with a white or bluish color to the skin. Swelling or blistering may occur following treatment. Complications may include hypothermia or compartment syndrome.

<span class="mw-page-title-main">Sprain</span> Damage to one or more ligaments in a joint

A sprain is a soft tissue injury of the ligaments within a joint, often caused by a sudden movement abruptly forcing the joint to exceed its functional range of motion. Ligaments are tough, inelastic fibers made of collagen that connect two or more bones to form a joint and are important for joint stability and proprioception, which is the body's sense of limb position and movement. Sprains may be mild, moderate, or severe, with the latter two classes involving some degree of tearing of the ligament. Sprains can occur at any joint but most commonly occur in the ankle, knee, or wrist. An equivalent injury to a muscle or tendon is known as a strain.

<span class="mw-page-title-main">Orthopedic surgery</span> Branch of surgery concerned with the musculoskeletal system

Orthopedic surgery or orthopedics is the branch of surgery concerned with conditions involving the musculoskeletal system. Orthopedic surgeons use both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors, and congenital disorders.

<span class="mw-page-title-main">Genu varum</span> Varus deformity marked by (outward) bowing at the knee

Genu varum is a varus deformity marked by (outward) bowing at the knee, which means that the lower leg is angled inward (medially) in relation to the thigh's axis, giving the limb overall the appearance of an archer's bow. Usually medial angulation of both lower limb bones is involved.

<span class="mw-page-title-main">Joint dislocation</span> Medical injury

A joint dislocation, also called luxation, occurs when there is an abnormal separation in the joint, where two or more bones meet. A partial dislocation is referred to as a subluxation. Dislocations are often caused by sudden trauma on the joint like an impact or fall. A joint dislocation can cause damage to the surrounding ligaments, tendons, muscles, and nerves. Dislocations can occur in any major joint or minor joint. The most common joint dislocation is a shoulder dislocation.

<span class="mw-page-title-main">Hemipelvectomy</span> Surgical removal of half of the pelvis

Hemipelvectomy, also known as a pelvic resection, is a surgical procedure that involves the removal of part of the pelvic girdle. This procedure is most commonly performed to treat oncologic conditions of the pelvis. Hemipelvectomy can be further classified as internal and external hemipelvectomy. An internal hemipelvectomy is a limb-sparing procedure where the innominate bone is resected while preserving the ipsilateral limb. An external hemipelvectomy involves the resection of the innominate bone plus amputation of the ipsilateral limb.

Kneecapping is a form of malicious wounding, often as torture, in which the victim is injured in the knee. The injury is typically inflicted by a low-velocity gunshot to the knee pit with a handgun. The term is considered a misnomer by medical professionals because only a very small minority of victims suffer damage to the kneecap. A review of eighty kneecapping victims found that only two had a fractured kneecap. Some victims have their elbows and ankles shot as well.

Phantom pain is a painful perception that an individual experiences relating to a limb or an organ that is not physically part of the body, either because it was removed or was never there in the first place.

<span class="mw-page-title-main">Blunt trauma</span> Trauma to the body without penetration of the skin

Blunt trauma, also known as blunt force trauma or non-penetrating trauma, describes a physical trauma due to a forceful impact without penetration of the body's surface. Blunt trauma stands in contrast with penetrating trauma, which occurs when an object pierces the skin, enters body tissue, and creates an open wound. Blunt trauma occurs due to direct physical trauma or impactful force to a body part. Such incidents often occur with road traffic collisions, assaults, sports-related injuries, and are notably common among the elderly who experience falls.

Rotationplasty, commonly known as a Van Nes rotation or Borggreve rotation, is a type of autograft wherein a portion of a limb is removed, while the remaining limb below the involved portion is rotated and reattached. This procedure is used when a portion of an extremity is injured or involved with a disease, such as cancer.

An open fracture, also called a compound fracture, is a type of bone fracture that has an open wound in the skin near the fractured bone. The skin wound is usually caused by the bone breaking through the surface of the skin. An open fracture can be life threatening or limb-threatening due to the risk of a deep infection and/or bleeding. Open fractures are often caused by high energy trauma such as road traffic accidents and are associated with a high degree of damage to the bone and nearby soft tissue. Other potential complications include nerve damage or impaired bone healing, including malunion or nonunion. The severity of open fractures can vary. For diagnosing and classifying open fractures, Gustilo-Anderson open fracture classification is the most commonly used method. This classification system can also be used to guide treatment, and to predict clinical outcomes. Advanced trauma life support is the first line of action in dealing with open fractures and to rule out other life-threatening condition in cases of trauma. The person is also administered antibiotics for at least 24 hours to reduce the risk of an infection.

<span class="mw-page-title-main">Tourniquet</span> Medical device

A tourniquet is a device that is used to apply pressure to a limb or extremity in order to stop the flow of blood. It may be used in emergencies, in surgery, or in post-operative rehabilitation.

Limb-sparing techniques, also known as limb-saving or limb-salvage techniques, are performed in order to preserve the look and function of limbs. Limb-sparing techniques are used to preserve limbs affected by trauma, arthritis, cancers such as high-grade bone sarcomas, and vascular conditions such as diabetic foot ulcers. As the techniques for chemotherapy, radiation, and diagnostic modalities improve, there has been a trend toward limb-sparing procedures to avoid amputation, which has been associated with a lower 5-year survival rate and cost-effectiveness compared to limb salvage in the long-run. There are many different types of limb-sparing techniques, including arthrodesis, arthroplasty, endoprosthetic reconstruction, various types of implants, rotationplasty, osseointegration limb replacement, fasciotomy, and revascularization.

Chronic limb threatening ischemia (CLTI), also known as critical limb ischemia (CLI), is an advanced stage of peripheral artery disease (PAD). It is defined as ischemic rest pain, arterial insufficiency ulcers, and gangrene. The latter two conditions are jointly referred to as tissue loss, reflecting the development of surface damage to the limb tissue due to the most severe stage of ischemia. Compared to the other manifestation of PAD, intermittent claudication, CLI has a negative prognosis within a year after the initial diagnosis, with 1-year amputation rates of approximately 12% and mortality of 50% at 5 years and 70% at 10 years.

<span class="mw-page-title-main">Gait deviations</span> Medical condition

Gait deviations are nominally referred to as any variation of standard human gait, typically manifesting as a coping mechanism in response to an anatomical impairment. Lower-limb amputees are unable to maintain the characteristic walking patterns of an able-bodied individual due to the removal of some portion of the impaired leg. Without the anatomical structure and neuromechanical control of the removed leg segment, amputees must use alternative compensatory strategies to walk efficiently. Prosthetic limbs provide support to the user and more advanced models attempt to mimic the function of the missing anatomy, including biomechanically controlled ankle and knee joints. However, amputees still display quantifiable differences in many measures of ambulation when compared to able-bodied individuals. Several common observations are whole-body movements, slower and wider steps, shorter strides, and increased sway.

<span class="mw-page-title-main">Limb telescoping</span>

Limb telescoping is the progressive shortening of a phantom limb as the cortical regions are reorganized following an amputation. During this reorganization, proximal portions of the residual limb are perceived as more distal parts of the phantom limb. Such effect is responsible for increased phantom pain due to the discrepancy between the patient’s body perception and their actual body. This effect may last from weeks up to years after post-amputation.

References

  1. ↑ Fathi, Nazila (2008-01-11). "Spate of Executions and Amputations in Iran" . The New York Times . Retrieved 2021-06-27.
  2. ↑ Chuback, Jennifer E. (March 2005). Whitelaw, W.A. (ed.). The history of rhinoplasty. 14th Annual History of Medicine Days. Calgary, Alberta, Canada: University of Calgary. pp. 10–15 – via ResearchGate.
  3. ↑ Kocharkarn W (Summer 2000). "Traumatic amputation of the penis" (PDF). Brazilian Journal of Urology. 26: 385–389. Archived (PDF) from the original on 2022-10-09 – via Official Journal of the Brazilian Society of Urology.
  4. ↑ Peters R (2005). Crime and Punishment in Islamic Law: Theory and Practice from the Sixteenth to the Twenty-First Century. Cambridge University Press. ISBN   9780521792264.
  5. ↑ Bosmia AN, Griessenauer CJ, Tubbs RS (July 2014). "Yubitsume: ritualistic self-amputation of proximal digits among the Yakuza". Journal of Injury and Violence Research. 6 (2): 54–6. doi:10.5249/jivr.v6i2.489. PMC   4009169 . PMID   24284812.
  6. ↑ Kepe T (March 2010). "'Secrets' that kill: crisis, custodianship and responsibility in ritual male circumcision in the Eastern Cape Province, South Africa". Social Science & Medicine. 70 (5): 729–35. doi:10.1016/j.socscimed.2009.11.016. PMID   20053494.
  7. ↑ Grisaru N, Lezer S, Belmaker RH (April 1997). "Ritual female genital surgery among Ethiopian Jews". Archives of Sexual Behavior. 26 (2): 211–5. doi:10.1023/a:1024562512475. PMID   9101034. S2CID   32053425.
  8. ↑ "Amputator". Merriam-Webster . Retrieved 28 June 2021.
  9. ↑ "Amputee". Merriam-Webster . Retrieved 28 June 2021.
  10. ↑ Maloney, T.R.; Dilkes-Hall, I.E.; Vlok, M (2022). "Surgical amputation of a limb 31,000 years ago in Borneo". Nature. 609 (7927): 547–551. Bibcode:2022Natur.609..547M. doi:10.1038/s41586-022-05160-8. PMC   9477728 . PMID   36071168.
  11. ↑ Pinzur MS, Stuck RM, Sage R, Hunt N, Rabinovich Z (September 2003). "Syme ankle disarticulation in patients with diabetes". The Journal of Bone and Joint Surgery. American Volume. 85 (9): 1667–72. doi:10.2106/00004623-200309000-00003. PMID   12954823.
  12. ↑ Ransom, Cliff (24 July 2003). "Did Climber Have to Cut Off Arm to Save Life?". National Geographic. Archived from the original on January 6, 2019. Retrieved 5 January 2019.
  13. ↑ Müller, Sabine (2009-01-05). "Body Integrity Identity Disorder (BIID)—Is the Amputation of Healthy Limbs Ethically Justified?". The American Journal of Bioethics. 9 (1): 36–43. doi:10.1080/15265160802588194. ISSN   1526-5161.
  14. 1 2 3 Panchbhavi, Vinod K (8 June 2021). "Guillotine Ankle Amputation". Medscape.
  15. ↑ Abdul W, Hickey B, Wilson C (April 2016). "Lower extremity compartment syndrome in the setting of iliofemoral deep vein thrombosis, phlegmasia cerulea dolens and factor VII deficiency". BMJ Case Reports. 2016: bcr2016215078. doi:10.1136/bcr-2016-215078. PMC   4854131 . PMID   27113791.
  16. ↑ Ragnarsson, Kristjan T.; Thomas, David C. (2003), "Cancer of the Limbs", Holland-Frei Cancer Medicine. 6th edition, BC Decker, retrieved 2024-01-09
  17. ↑ "Frostbite". nhs.uk. 2017-10-19. Retrieved 2022-06-29.
  18. 1 2 Handford, Charles; Thomas, Owen; Imray, Christopher H. E. (2017-05-01). "Frostbite". Emergency Medicine Clinics of North America. Wilderness and Environmental Medicine. 35 (2): 281–299. doi:10.1016/j.emc.2016.12.006. ISSN   0733-8627. PMID   28411928.
  19. ↑ Handford, Charles; Buxton, Pauline; Russell, Katie; Imray, Caitlin Ea; McIntosh, Scott E.; Freer, Luanne; Cochran, Amalia; Imray, Christopher He (2014). "Frostbite: a practical approach to hospital management". Extreme Physiology & Medicine. 3: 7. doi: 10.1186/2046-7648-3-7 . ISSN   2046-7648. PMC   3994495 . PMID   24764516.
  20. ↑ "Frostbite Clinical Presentation: History, Physical Examination, Complications". emedicine.medscape.com. Retrieved 2022-06-29.
  21. ↑ Murray, Shane (2002-01-22). "RTE: Aussie Rules star has finger removed". RTÉ.ie . Archived from the original on 2007-12-14. Retrieved 2007-10-19.
  22. ↑ Australian Rugby Union (2006-10-17). "Tawake undergoes surgery to remove finger". SportsAustralia.com. Archived from the original on 2013-05-01. Retrieved 2013-04-22.
  23. ↑ Klemko, Robert (2014-06-17). "Ronnie Lott's Amputated Pinkie Finger". Sports Illustrated . Archived from the original on 2022-08-15.
  24. ↑ "Burglar's hand to be amputated". gulfnews.com. Retrieved 2021-11-03.
  25. ↑ "Iranian chocolate thief faces hand amputation". BBC News Online . 2010-10-17. Retrieved 2021-06-28.
  26. ↑ Dovan, Fiona (2008-02-09). "Iran envoy defends amputation" . The Telegraph . Retrieved 2021-06-28.
  27. ↑ "Saudi Arabia chops off hand of Egyptian for theft". Monsters and Critics. 2007-11-05. Archived from the original on 2010-08-11. Retrieved 2021-06-27.
  28. ↑ "Yemeni man sentenced to hand and foot amputation for armed robbery". Amnesty International. 2013-09-16. Retrieved 2021-11-03.
  29. ↑ Bamford, David (2001-07-01). "Hand amputation in Nigeria". BBC News Online . Retrieved 2021-06-28.
  30. ↑ Bello, Ademola (2010-06-11). "Who Will Save Amputees of Sharia Law in Nigeria?". Huffington Post . Retrieved 2021-06-28.
  31. ↑ Tarabella, Marc. "Parliamentary question | VP/HR - Cross-amputation in Yemen | E-011050/2013 | European Parliament". www.europarl.europa.eu. Retrieved 2023-08-07.
  32. ↑ Peters, Rudolph (2005). Crime and Punishment in Islamic Law: Theory and Practice from the Sixteenth to the Twenty-First Century. Cambridge University Press. p. 166. ISBN   978-0-521-79226-4.
  33. ↑ "The Quran, sura 5, verse 33". www.perseus.tufts.edu.
  34. ↑ "Saudi Arabia: King urged to commute "cross amputation" sentences". Amnesty International. 2011-12-16. Retrieved 2023-08-07.
  35. ↑ "Sudanese man sentenced to cross amputation for committing armed robbery – African Centre for Justice and Peace Studies".
  36. ↑ Rice, Xan (20 October 2010). "Somali schoolboy tells of how Islamists cut off his leg and hand". The Guardian.
  37. ↑ "Shariah Punishments in the Islamic Republics of Mauritania and Maldives, and Islamic State of Yemen". academic.oup.com.
  38. ↑ Pannier, Bruce. "Criminals Lose Hands And Feet As Shari'a Law Imposed". RadioFreeEurope/RadioLiberty.
  39. ↑ Staff, Newsweek (8 July 2010). "The World's Most Barbaric Punishments". Newsweek.
  40. ↑ Boyd, Julian P., ed. (1950). "Bill No. 64. A Bill for Proportioning Crimes and Punishments in Cases Heretofore Capital" . The Papers of Thomas Jefferson . Vol. 2. Princeton University Press. pp. 492–507.
  41. 1 2 Wilson, Gaye (May 1999). "Bill 64". Thomas Jefferson Encyclopedia. Thomas Jefferson Foundation.
  42. ↑ Boyd 1950 , p. 505
  43. ↑ Boyd 1950 , pp. 497, 506n12
  44. ↑ Boyd 1950 , p. 498
  45. ↑ Boyd 1950 , pp. 505–506
  46. ↑ Boyd 1950 , p. 493. Jefferson cited a work of Stamford and the Offences within the Court Act 1541 (33.H.8 c. 12).
  47. ↑ "AIUK : Somalia: Amputation punishments are 'torture' says Amnesty". Archived from the original on 2013-10-03. Retrieved 2021-01-08.
  48. ↑ Smith DG (2004). "Chapter 2. General principles of amputation surgery.". Atlas of Amputations and Limb Deficiencies: Surgical, Prosthetic and Rehabilitation Principles. American Academy of Orthopaedic Surgeons. pp. 21–30. ISBN   978-0892033133.
  49. ↑ Springer, Shira (2018-04-13). "How The Marathon Bombing Helped Bring Innovation To Amputation". WBUR . Retrieved 2021-06-28.
  50. ↑ "Jim Ewing, Dynamic-Model Amputation Patient". Brigham and Women's Faulkner Hospital. 2016-11-21. Retrieved 2021-06-28.
  51. ↑ New surgery may enable better control of prosthetic limbs
  52. ↑ Agonist-antagonist Myoneural Interface (AMI)
  53. ↑ "Ertl Reconstruction - amputation". www.ertlreconstruction.com. Retrieved 2018-11-24.
  54. ↑ Fischgrund JS (June 2016). "JAAOS Research". The Journal of the American Academy of Orthopaedic Surgeons. 24 (6): 392. doi:10.5435/jaaos-d-16-00309. PMID   27213622.
  55. ↑ Kwah LK, Webb MT, Goh L, Harvey LA (June 2019). "Rigid dressings versus soft dressings for transtibial amputations". The Cochrane Database of Systematic Reviews. 2019 (6): CD012427. doi:10.1002/14651858.cd012427.pub2. PMC   6573094 . PMID   31204792.
  56. ↑ Reichmann JP, Stevens PM, Rheinstein J, Kreulen CD (May 2018). "Removable Rigid Dressings for Postoperative Management of Transtibial Amputations: A Review of Published Evidence". PM&R. 10 (5): 516–523. doi:10.1016/j.pmrj.2017.10.002. PMID   29054690. S2CID   21732925.
  57. ↑ Smith DG, Skinner HB (2014). "Amputations". In Skinner HB, McMahon PJ (eds.). Current Diagnosis & Treatment in Orthopedics (5th ed.). McGraw-Hill Education. ISBN   978-0-07-159075-4.
  58. 1 2 Watson N (1986). Hand Injuries and Infections. London: Gower Medical. ISBN   0906923808.
  59. ↑ Ramirez C, Menaker J (2017-05-01). "Traumatic Amputations". Trauma Reports. 18 (3).
  60. ↑ Johansen K, Daines M, Howey T, Helfet D, Hansen ST (May 1990). "Objective criteria accurately predict amputation following lower extremity trauma". The Journal of Trauma. 30 (5): 568–72, discussion 572–3. doi: 10.1097/00005373-199005000-00007 . PMID   2342140.
  61. ↑ "Amputation". nhs.uk. 2017-10-17. Retrieved 2022-09-07.
  62. ↑ Davison, Ben, ed. (February 2011). "Scuba Tanks as Lethal Weapons". Undercurrent. Vol. 26, no. 2. Sausalito, California. pp. 8–9. Archived from the original on 2021-04-28. Retrieved 28 June 2021.
  63. ↑ Clasper, Jon; Ramasamy, Arul (2013). "Traumatic amputations". British Journal of Pain. 7 (2): 67–73. doi:10.1177/2049463713487324. ISSN   2049-4637. PMC   4590129 . PMID   26516502.
  64. 1 2 "American Statistical Association (ASA)". www.amstat.org.
  65. ↑ Weiss AJ, Elixhauser A, Steiner C (April 2013). "Readmissions to U.S. Hospitals by Procedure, 2010". HCUP Statistical Brief #154. Rockville, Maryland: U.S. Agency for Healthcare Research and Quality. PMID   24006552.
  66. ↑ McDonald, Cody L.; Westcott-McCoy, Sarah; Weaver, Marcia R.; Haagsma, Juanita; Kartin, Deborah (2021-04-01). "Global prevalence of traumatic non-fatal limb amputation". Prosthetics and Orthotics International. 45 (2): 105–114. doi:10.1177/0309364620972258. ISSN   1746-1553. PMID   33274665.
  67. ↑ "Gangrene". www.hopkinsmedicine.org. 2019-11-19. Retrieved 2023-10-31.
  68. ↑ CDC (2023-04-07). "Preventing Diabetes-Related Amputations (Part 1)". Centers for Disease Control and Prevention. Retrieved 2023-10-31.
  69. ↑ "Avoiding Amputations". Temple Health. Retrieved 2023-10-31.
  70. ↑ "Hyperbaric oxygen therapy - Mayo Clinic". www.mayoclinic.org. Retrieved 2023-10-31.
  71. ↑ Bouskela E, Donyo KA (May 1997). "Effects of oral administration of purified micronized flavonoid fraction on increased microvascular permeability induced by various agents and on ischemia/reperfusion in the hamster cheek pouch". Angiology. 48 (5): 391–9. doi:10.1177/000331979704800503. PMID   9158383. S2CID   28978927. Archived from the original on 2010-11-25. Retrieved 2010-06-24.
  72. ↑ Dillon RS (May 1997). "Patient assessment and examples of a method of treatment. Use of the circulator boot in peripheral vascular disease". Angiology. 48 (5 Pt 2): S35–58. doi:10.1177/000331979704800504. PMID   9158380. S2CID   23512929. Archived from the original on 2010-11-25. Retrieved 2010-06-24.
  73. ↑ Vella A, Carlson LA, Blier B, Felty C, Kuiper JD, Rooke TW (2000). "Circulator boot therapy alters the natural history of ischemic limb ulceration". Vascular Medicine. 5 (1): 21–5. doi:10.1177/1358836X0000500104. PMID   10737152.
  74. ↑ Williams, Vivien (2008-07-11). Circulator Boot (video). Mayo Clinic News Network. Event occurs at 1:08–1:32. Retrieved 2021-06-27.
  75. ↑ Roon, Anthony J.; Moore, Wesley S.; Goldstone, Jerry (1977). "Below-knee amputation: A modern approach". The American Journal of Surgery. 134 (1): 153–158. doi:10.1016/0002-9610(77)90299-9. ISSN   0002-9610. PMID   879408.
  76. 1 2 "Amputation". www.hopkinsmedicine.org. 2023-03-15. Retrieved 2023-10-31.
  77. ↑ Schultz H (January 2005). "The Science of Things". National Geographic Magazine. Archived from the original on September 6, 2008.
  78. ↑ MacIver, K.; Lloyd, D. M.; Kelly, S.; Roberts, N.; Nurmikko, T. (August 2008). "Phantom limb pain, cortical reorganization and the therapeutic effect of mental imagery". Brain. 131 (8): 2181–2191. doi:10.1093/brain/awn124. ISSN   0006-8950. PMC   2494616 . PMID   18567624.
  79. ↑ Ryan J (March 25, 2006). "War without end / Damaged soldiers start their agonizing recoveries". The San Francisco Chronicle. Archived from the original on February 8, 2011. Retrieved June 4, 2017.
  80. ↑ Hoock, Maja (September 2021). "Innovative prostheses positively change the Paralympics". WIPO. Retrieved October 30, 2023.
  81. ↑ Robbins JM, Strauss G, Aron D, Long J, Kuba J, Kaplan Y (November 2008). "Mortality rates and diabetic foot ulcers: is it time to communicate mortality risk to patients with diabetic foot ulceration?". Journal of the American Podiatric Medical Association. 98 (6): 489–93. doi:10.7547/0980489. PMID   19017860. S2CID   38232703.
  82. ↑ Savage PE (1983). "The diabetic foot". Problems in Peripheral Vascular Disease. Springer Netherlands. pp. 69–73. doi:10.1007/978-94-011-6648-5_12. ISBN   9789401166508.
  83. ↑ Lowe, Peter (1612). A discourse of the whole art of chyrurgerie. Wherein is exactly set downe the definition, causes, accidents, prognostications, and cures of all sorts of diseases ... Wherunto is added the rule of making remedies which chirurgions doe commonly use: with the Presages of divine Hyppocrates. Wellcome Library. London : Thomas Purfoot.

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