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Amputation - traumatic

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 injury.

Alternative Names

Loss of a body part

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 injury, the partially severed extremity 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. See also: Wounds

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 techniques, early rehabilitation, and new prosthetic designs. New limb replantation techniques have been moderately successful, but incomplete nerve regeneration remains a major limiting factor.

Often, the patient 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. Natural disasters, war, and terrorist attacks can also cause traumatic amputations.

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)

First Aid

1. Check the person's airway (open if necessary); check breathing and circulation. If necessary, begin rescue breathing, CPR, or bleeding control.
2. Try to calm and reassure the person as much as possible. Amputation is painful and extremely frightening.
3. Control bleeding by applying direct pressure to the wound, by elevating the injured 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 person is suffering from life-threatening bleeding, a constriction bandage or tourniquet will be easier to use than compression of pressure points.
4. Save any severed body parts and ensure that they stay with the patient. Remove contaminating material if possible, and gently rinse the body part if the cut end is contaminated with dirt. Wrap 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 do NOT put the severed part directly on ice. Do NOT use dry ice as this will cause frostbite and injury to the part. If cold water is not available, keep the part away from heat as much as possible. Save it for the medical team, or take it to the hospital. Cooling the severed part will keep it viable for about 18 hours. Without cooling, it will only remain useable for about 4 to 6 hours.
5. Take steps to prevent shock. Lay the person flat, raise the feet about 12 inches, and cover the person with a coat or blanket. Do NOT place the person in this position if a head, neck, back, or leg injury is suspected or if it makes the victim uncomfortable.
6. Once the bleeding at the site of the amputation is under control, examine the person for other signs of injury that require emergency treatment. Treat fractures, additional cuts, and other injuries appropriately.
7. Stay with the person until medical help arrives.

Do Not

• Do NOT forget that saving the victim's life is more important than saving a body part.
• Do NOT overlook other, less obvious, injuries.
• Do NOT attempt to push any part back into place.
• Do NOT decide that a body part is too small to save.
• Do NOT place a tourniquet, unless the bleeding is life threatening, as the entire limb may be placed in jeopardy.
• Do NOT raise false hopes of reattachment.

Call immediately for emergency medical assistance if

If someone severs a limb, finger, toe, or other body part, you should call immediately for emergency medical help.

Prevention

Use safety equipment when using factory, farm, or power tools. Wear seat belts when driving a motor vehicle. Always use good judgment and observe appropriate safety precautions.

References

Halluska-Handy M. Management of amputations. In: Roberts JR, Hedges JR, eds. Clinical Procedures in Emergency Medicine. 5th ed. Philadelphia, Pa: Saunders Elsevier; 2009:chap 47.

Lyn ET, Mailhot T. Hand. In: Marx JA, ed. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa: Mosby Elsevier; 2009:chap 47.