Amputation Reconstruction - An Overview

What Is Amputation?

Amputation is a surgical process where a part or whole limb or extremity is removed for various reasons, including any trauma or infection or underlying health conditions such as diabetes and peripheral arterial disease. People can have a healthy and active lifestyle after amputation, but living without a limb may take time. After the surgical amputation, the surgeon may recommend a prosthetic limb. Today's prosthetics are very comfortable, lightweight, and highly functional and are very comfortable to use. This helps to live a normal lifestyle even after losing a limb.

What Are the Various Types of Amputation Surgeries?

The following are the types of amputation surgeries:

• Amputation above the knee, where part of the thigh, knee, shin, foot, and toes are removed.

• Amputation below the knee and surgical removal of the lower leg, foot, or toes are done.

• Amputation of the arm, involving partial hand amputation, below-the-elbow amputation, wrist amputation, above-the-elbow amputation, shoulder disarticulation, elbow disarticulation, elbow disarticulation, removing an arm or part of the shoulder (forequarter amputation).

• Foot amputation is where a part or whole foot is removed.

• Finger amputation.

• Toe amputation.

• Hand amputation.

• Double amputation, involves the removal of both legs, arms, feet, and hands.

What Are the Potential Reasons for Amputation?

Amputation is recommended to prevent the spread of infection through the limbs and to prevent pain. The most common reason for amputation is a wound that does not heal due to insufficient blood supply to the limb. After a severe injury, which includes a crushing injury, amputation may be recommended when the surgeon cannot reconstruct or repair the damaged limb.

Amputation is also recommended under the following conditions:

• Diabetes leads to poor healing of wounds and results in dead tissues.

• Frostbite.

• Severe injuries from gangrene or dead tissue.

• Thickening of nerve tissue or neuroma.

• Peripheral arterial disease.

• Blockage in blood vessels.

• Malignant tumors in the limb.

What Are the Advantages of an Amputation?

The following are the advantages of amputation:

• Prevents the spread of infection in the limb.

• It helps to manage severe pain.

What Are the Risks or Complications of an Amputation?

Like any other surgical procedure, amputation involves the following risks and complications:

• Bleeding.

• Swelling.

• Infection.

• Wound.

• Pain.

• Fever.

• Muscle weakness.

What Are the Procedures for Amputation Reconstruction?

The following are the procedures that are involved in amputation reconstruction:

• Target muscle reinnervation is a surgical procedure limiting chronic pain and prosthesis infection.

• Regenerating the peripheral nerve interface with the amputated limb helps stimulate nerves, manage pain, and improve the nerves' functioning.

• Osseointegration (joining with the bone) is done where the prosthesis is integrated and permanently placed into the bone.

• The surgery for amputated limbs and nerve endings is revised to reduce the pain that is caused due to the ill-fitting prosthesis.

• A myoelectric prosthesis is adjusted and uses electrodes to respond to stimuli that are created when the muscles are flexed.

What Are the Different Types of Amputation Reconstruction Done?

The following are the various types of amputation reconstruction:

• Standard Amputation: This is the commonly used amputation where the surgeons remove limbs and attached muscles, and the cut end is covered with the skin. If the patient requires or is interested in a prosthesis, the cut end is covered with soft tissue so that the person feels comfortable with a prosthesis and bears weight without any pain. Even the infection and tissue breakdown are also reduced.

• Osseointegration Amputation Reconstruction: Osseointegration is a term that is used when the bone gets ingrown into a metal implant. A surgical procedure is done, and the metal implant or prosthesis is permanently implanted or attached to the person's natural bone. The patient's bone grows and integrates with the artificial implant. Osseointegration is the best, safest, and most successful method in dental implants and joint replacement surgeries. Osseointegration is considered the major advantage of amputation surgery.

• Multi Ligamentous Reconstruction: Multiligamentous reconstruction is recommended in below-knee amputations when the patient's condition is severe, and the treatment is controversial. This may be a complex process starting with sufficiently identifying the injured area. A complete radiographic and physical examination is done for a thorough understanding of the anatomy of the knee that helps to assess the damaged structures, including the anterior cruciate ligament, posterior cruciate ligament, posteromedial corner including medial collateral ligament, and postero-lateral corner that includes lateral collateral ligament.

• Rotationplasty: When the rotationplasty is done, a recommended option for a few patients with a bone or soft tissue tumor, surgeons remove the part of the limb where the tumor is located. Any healthy tissue below the tumor is turned around and re-attached. For example, in the case of cancer surgery, where amputation of the person’s knee is required, the bone and tissue of the ankle on that leg can be healthy. A rotationplasty can rotate the lower leg, and the ankle joint is used to replace the lower leg and knee.

How Long Will It Take To Get Adjusted to the Artificial Prosthesis?

Even after the amputation, not all of the patient's body may accept the prosthetic reconstruction. Assessing whether the person is suitable for the prosthesis is very important. The prosthetic limbs resemble the natural limb, and the prosthesis, after attachment, takes six to eight weeks to get used to it. The physiotherapist may help the person with small exercises that help the person get used to the prosthesis as early as possible.

• The physical therapist may also guide the following:

• How to put on and remove the prosthesis?

• How to walk with the prosthesis?

• How to take proper care of prosthetic limbs?

Conclusion:

The amputation reconstruction surgery is recommended in patients where limb amputation is done. An amputation is a surgical removal of a limb due to any trauma, infection, or underlying health conditions. Patients with amputated limbs cannot walk or have a normal life due to the loss of a limb. A prosthesis can replace this. The surgeon and the physical therapist help a person to live a normal life through the surgical placement of the prosthesis and with the physical exercises that ease the movement of the prosthesis.