There are two main types of amputation: lower limb amputation, where the foot and part of the leg are removed; and upper limb amputation, where the hand and part of the arm are removed.
An amputation can also be:
- minor, where only a toe, finger or part of the foot or hand is removed
- major, where a large part of the limb is removed
Lower limb amputations
The most common type of major amputation, accounting for more than half of all cases in the UK, is a type of lower limb amputation known as transtibial amputation. This is where the bottom section of a leg is amputated beneath the knee. A transtibial amputation is also known as a below-knee amputation.
Other types of lower limb amputation, listed in order of how commonly they are performed in the UK, are:
- lower digit amputation, where one or more of the toes are amputated
- transfemoral, where both the bottom half of the leg and part of the thigh above the knee are amputated, also known as an above-knee amputation
- double lower amputation, where both legs are amputated, usually below the knee
- knee disarticulation, where the amputation is performed through the middle of the knee joint
- partial foot amputation, where the toes and lower half of the foot are amputated
- hip disarticulation, where the amputation takes place through the hip joint, removing the entire leg
- hemipelvectomy, where an entire leg and a section of the pelvis are amputated (a hemipelvectomy is the rarest type of lower limb amputation, usually only reserved for the most serious and extensive cases of damage to the limb)
Upper limb amputations
Most upper limb amputations are needed because the hand and arm have been damaged by a traumatic injury.
The main types of upper limb amputation, listed in order of how commonly they are performed in the UK, are:
- upper digit amputation, where the thumb or one or more of the fingers are amputated
- transhumeral, where the hand and a section of the arm are amputated above the elbow
- transradial, where the hand and a section of the arm are amputated below the elbow
- partial hand amputation, where a section of the hand is amputated
- shoulder disarticulation, where the amputation occurs through the shoulder joint, removing the entire arm
- double upper amputations, where both hands and some of the arms are amputated
- forequarter amputation, where the entire arm is amputated along with a section of the shoulder blade and collar bone
- wrist disarticulation, where the amputation occurs through the wrist joint, removing the hand
- elbow disarticulation, where the amputation occurs through the elbow joint, removing the hand, wrist and forearm
Unless your amputation is performed as an emergency, you will probably go through a number of tests and procedures before the amputation takes place. These are designed to assess the type of amputation suitable for you and anything that may affect your rehabilitation.
These tests and procedures may include:
- a thorough medical examination, including assessing your physical condition, nutritional status, bowel and bladder function and the various systems of your body, such as your cardiovascular system (heart, blood and blood vessels) and your respiratory system ( lungs and airways)
- an assessment of the condition and function of the healthy limb. Removing one limb can place extra strain on the remaining limb, so it is important to reduce any potential risk of amputation of the remaining limb at a later date
- a psychological assessment to determine how well you will cope with the psychological and emotional impact of amputation and whether you will require additional support
- an assessment of your home, work and social environments to determine whether any additional provisions will need to be made to help you cope
After the pre-operative assessment, the surgeon should be able to tell you the type of amputation you need.
You will also be introduced to a physiotherapist, who will be involved in your post-operative care and, if necessary, a prosthetist (a specialist in prosthetic limbs) who will tell you more about the type and function of prosthetic limbs (or other devices) available.
Things that will influence the type of prosthetic limb recommended for you include:
- the type of amputation
- the amount of muscle strength in the remaining section of the limb
- your general state of health
- tasks the prosthetic limb will be expected to perform, such as whether you have a desk or manual job and what type of hobbies you have
- whether you want the limb to look as physically real as possible or whether you are more concerned with being able to use the limb for a wide range of activities
You may have to decide between having a prosthetic that is physically realistic or one that is functionally useful. However, it is possible to have a prosthetic limb that is both physically realistic and fully (or mostly) functional.
Many people planning to have an amputation find it both reassuring and useful to talk to somebody who has gone through a similar type of amputation. A member of your care team may be able to put you in touch with someone.
An amputation is carried out under a general anaesthetic or an epidural anaesthetic, so you will feel no pain during surgery.
Ideally, as much of the limb as possible should be spared as this will mean you will have a greater range of movement and functional ability in your prosthetic limb.
A number of additional techniques can be used during surgery to help improve the remaining limb function and reduce the risk of complications. These include:
- shortening and smoothing the bone in your remaining limb so it is covered by an adequate amount of soft tissue and muscle
- stitching the remaining muscle to the bones to help strengthen your remaining limb
After the amputation, the remaining stump wound is sealed with stitches or staples.
Reattaching a limb
If part of the body is accidentally cut off during a guillotine injury, it is often possible to reattach (replant) the body part using surgery. However, the same is not usually true for crush or avulsion injuries, as the damage to surrounding tissue is usually too extensive.
If you or somebody you know has a guillotine injury that causes a body part to become completely detached:
- immediately dial 999 for an ambulance
- while waiting for the ambulance, clean the wound with water
- try to stem the bleeding by covering the wound with a pressure bandage
- take the detached body part and cover it in sterile gauze, if available
- place the body part in a resealable plastic bag or waterproof container
- surround the container or bag with ice
Do not place the body part in direct contact with ice as this could damage the tissue.
Digits, such as fingers and toes, can survive for up to eight hours if properly stored and chilled. Extremities, such as hands, arms, feet and legs, can survive for up to six hours.
Replantation of the body part involves reattaching the various muscle groups, nerves, tendons and blood vessels.
The success rate for replantation surgery is around 80%.
However, replanting a body part may not always be recommended. For example, replanting the feet and legs is not usually recommended as most people will function better with prosthetic limbs than reattached limbs.