Traumatic amputation involves the accidental loss of a body part, usually a finger, a toe, an arm, or a leg. In complete amputation, the member is totally severed; in partial amputation, some soft-tissue connection remains.
The prognosis has improved as a result of early improved emergency and critical care management, new surgical techniques, early rehabilitation, prosthesis fitting, and new prosthesis design. New limb reimplantation techniques have been moderately successful, but incomplete nerve regeneration remains a major limiting factor.
Causes
Traumatic amputations usually result directly from accidents at a factory or farm, or from power tools or motor vehicle accidents.
Diagnosis
Any patient with a traumatic amputation requires careful monitoring of vital signs as well as assessment for other traumatic injuries. If amputation involves more than just a finger or a toe, assessment of airway, breathing, and circulation is also required. Because profuse bleeding is likely, watch for signs of hypovolemic shock, and draw blood for hemoglobin level, hematocrit, and typing and crossmatching. If the patient has a partial amputation, check for pulses distal to the amputation.
Treatment
Because the greatest immediate threat after traumatic amputation is blood loss and hypovolemic shock, emergency treatment consists of local measures to control bleeding, fluid replacement with normal saline solution and colloids, and blood replacement as needed.
Reimplantation remains controversial, but it’s becoming more common and successful because of advances in microsurgery. If reconstruction or reimplantation is possible, surgical intervention attempts to preserve usable joints. When arm or leg amputations are done, the surgeon creates a stump to be fitted with a prosthesis. A rigid dressing permits early prosthesis fitting and rehabilitation.
Special considerations
Traumatic amputations usually result directly from accidents at a factory or farm, or from power tools or motor vehicle accidents.
Diagnosis
Any patient with a traumatic amputation requires careful monitoring of vital signs as well as assessment for other traumatic injuries. If amputation involves more than just a finger or a toe, assessment of airway, breathing, and circulation is also required. Because profuse bleeding is likely, watch for signs of hypovolemic shock, and draw blood for hemoglobin level, hematocrit, and typing and crossmatching. If the patient has a partial amputation, check for pulses distal to the amputation.
Treatment
Because the greatest immediate threat after traumatic amputation is blood loss and hypovolemic shock, emergency treatment consists of local measures to control bleeding, fluid replacement with normal saline solution and colloids, and blood replacement as needed.
Reimplantation remains controversial, but it’s becoming more common and successful because of advances in microsurgery. If reconstruction or reimplantation is possible, surgical intervention attempts to preserve usable joints. When arm or leg amputations are done, the surgeon creates a stump to be fitted with a prosthesis. A rigid dressing permits early prosthesis fitting and rehabilitation.
Special considerations
- During emergency treatment, monitor vital signs (especially if the patient is experiencing hypovolemic shock), clean the wound, and give tetanus prophylaxis, an analgesic, and an antibiotic as needed.
- After partial amputation, position the limb in normal alignment, and drape it with towels or dressings soaked in sterile normal saline solution.
- Preoperative care includes thorough wound irrigation and debridement (using a local nerve block).
- Postoperative dressing changes using sterile technique help prevent skin infection and ensure skin graft viability.
- Help the amputee cope with his altered body image. Reinforce exercises and prevent stump trauma.
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