Traumatic Amputation

Definition Traumatic amputation is the loss of a body part -- usually a finger, toe, arm, or leg-- that occurs as the result of an accident or trauma. Considerations If an accident or trauma results in complete amputation (the body part is totally severed), the part sometimes can be reattached, especially when proper care is taken of the severed part and stump. In a partial amputation, some soft-tissue connection remains. Depending on the severity of the in ury, the partially severed e!tremity may or may not be able to be reattached. There are various complications associated with amputation of a body part. The most important of these are bleeding, shock, and infection. ("ee wounds for more information.) The long-term outcome for amputees has improved due to better understanding of the management of traumatic amputation, early emergency and critical care management, new surgical techni#ues, early rehabilitation, and new prosthetic designs. $ew limb replantation techni#ues have been moderately successful, but incomplete nerve regeneration remains a ma or limiting factor. %ften, the traumatic amputee will have a better outcome from having a well-fitting, functional prosthesis than a nonfunctional replanted limb. Causes Traumatic amputations usually result directly from factory, farm, or power tool accidents or from motor vehicle accidents. $atural disasters, war, and terrorist attacks can also cause traumatic amputations. Symptoms & body part that has been completely or partially cut off

 'leeding (may be minimal or severe, depending on the location and nature of the in ury) (ain (the degree of pain is not always related to the severity of the in ury or the amount of bleeding) )rushed body tissue (badly mangled, but still partially attached by muscle, bone, tendon or skin) First Aid 1. )heck the victim*s airway (open if necessary)+ check breathing and circulation. If necessary, begin rescue breathing, )(, or bleeding control. 2. Try to calm and reassure the victim as much as possible. &mputation is painful and e!tremely frightening. 3. )ontrol bleeding by applying direct pressure to the wound, by elevating the in ured area, and, if necessary, by using pressure point bleeding control. If the bleeding continues, recheck the source of the bleeding and reapply direct pressure, with help from someone who is not fatigued. If the victim is suffering from life-threatening bleeding, a constriction bandage or tourni#uet will be easier to use than compression of pressure points. 4. "ave any severed body parts and ensure that they stay with the patient. ,emove contaminating material if possible, and gently rinse the body part if the cut end is contaminated with dirt. -rap the severed part in a clean, damp cloth, place it in a sealed plastic bag and immerse the bag in cold water (ice water if available). Do not directly immerse the part in water and don*t put the severed part directly on ice. Do not use dry ice as this will cause frostbite and in ury to the part. If cold water is not available, keep the part away from heat as much as possible. "ave it for the emergency personnel, or take it to the hospital. )ooling the severed part will keep it viable for

about ./ hours. -ithout cooling, it will only remain viable for about 0 to 1 hours. 5. Take steps to prevent shock. 2ay the victim flat, raise the feet about .3 inches and cover the victim with a coat or blanket. D% $%T place the victim in this position if a head, neck, back or leg in ury is suspected or if it makes the victim uncomfortable. 6. %nce the bleeding at the site of the amputation is under control, e!amine the person for other signs of in ury that re#uire emergency treatment. Treat fractures, additional cuts and other in uries appropriately. 7. "tay with the victim until medical help is obtained.
Replantation

& number of factors influence whether an amputated part can be successfully reattached. These include4 age of the patient (younger patients tend to heal better and faster) location of amputation (replantations of the upper e!tremities are more successful than those of the lower e!tremities) type of wound (sharp wounds are repaired more successfully than crushing in uries) health of the patient (e.g. if he or she is able to withstand prolonged surgery) amount of contamination to the wound (a grossly

contaminated part has a much lower chance of successfully being reattached) length of time the amputated part was detached from the body (chance of successful replantation decreases after si! hours)
Post-Care

Techni#ues

such

as

biofeedback,

cognitive-behavioral

pain

management, hypnosis, acupuncture, ultrasound, and physical therapy have all been used to treat post-amputation and phantom pain.
Nutritional Concerns

(roper nutrition is essential to optimi5e healing after an amputation or reattachment surgery. & well-balanced diet rich in vitamins and with ade#uate caloric value is recommended to promote healing. (rognosis (ossible complications of traumatic amputation include4 e!cessive bleeding and shock infection muscle shortening pulmonary embolism death Improved medical and surgical care and rehabilitation have

improved the long-term outlook for such patients. )hildren tend to heal faster than adults and adapt more #uickly to disability. Do Not D% $%T forget that saving the victim*s life is more important than saving a body part. D% $%T overlook other, less obvious, in uries. D% $%T attempt to push any part back into place. D% $%T decide that a body part is too small to save. D% $%T place a tourni#uet, unless the bleeding is life threatening, as the entire limb may be placed in eopardy. D% $%T raise false hopes of reattachment. Call immediately for emergency medical assistance if If a victim severs a limb, finger, toe, or other body part, you should call immediately for emergency medical assistance.

Prevention 6se safety e#uipment when using factory, farm, or power tools. -ear seat belts when driving a motor vehicle. &lways use good udgment and observe appropriate safety precautions.