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Amputation - Traumatic

Alternate Names : Loss of a Body Part

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 the factory or farm, or from power tools or motor vehicle accidents.

Assessment

Every traumatic amputee requires careful monitoring of vital signs. 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. In partial amputation, check for pulses distal to the amputation. After any traumatic amputation, assess for other traumatic injuries as well.

Signs and symptoms

• A body part that has been completely or partially cut off
• Bleeding (may be minimal or severe, depending on the location and nature of the injury)
• Pain (the degree of pain is not always related to the severity of the injury or the amount of bleeding)
• Crushed body tissue (badly mangled, but still partially attached by muscle , bone, tendon or skin)

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 in hypovolemic shock), clean the wound, and give tetanus prophylaxis, analgesics, and antibiotics as needed.
• 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.
• DO NOT attempt to push any part back into place.
• Help the amputee cope with his altered body image. Reinforce exercises and prevent stump trawna.
• DO NOT place a tourniquet, unless the bleeding is life threatening, as the entire limb may be placed in jeopardy.