Traumatic Amputations Health Article

Definition

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.

Description

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 and 30.

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

Causes and symptoms

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. Persons who lose little blood and have less severe injuries sometimes feel more pain than those who bleed heavily and whose injuries are life-threatening.

Diagnosis

When an injured person 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 person's age and general health. This is one of the diagnostic tools used to determine the probability of success for reattachment surgery. 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 an injured person's wishes and lifestyle. Additional concerns are how and to what extent the amputation will affect an individual's quality of life and ability to perform everyday activities.

Treatment

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

Muscle tissue dies quickly, but a well-preserved body 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.

Initial response

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 injured person can breathe. If not, clear an airway and administer CPR as necessary.
• Use direct pressure to control bleeding, but minimize or avoid contact with blood and other body fluids.
• Persons should not be moved if back, head, leg, or neck injuries are suspected or if motion causes pain. If none are found by an emergency medical technician (EMT), put the injured person in a supine (back down) position flat with the feet raised 1 ft (0.3 m) above the surface.
• Cover the person 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 a person's life is always more important than recovering the amputated part(s). Transporting the injured person to a hospital or emergency center should never be delayed until missing pieces are located.

Preserving tissue

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.

Prognosis

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 persons experiencing a traumatic amputation.