AMPUTATION

DEFINITION

Amputation is the surgical removal of all or

part of a limb or extremity such as an arm,
leg, foot, hand, toe, or finger.
 Etiology
• Trauma (most common)

• Pheripheral Vascular Disease

• Malignancy

• Severe Infection

• Frost bite

• Severe injury
Primary amputation indication
• Severely crushed or mangled parts
• No bone support for reconstruction
• Anticipated functional outcome of
amputation is superior than successful
replantation or reconstruction
• Other serious injuries or diseases
• Prolonged ischemia time
• Severe contamination
• Psychological instability
 TYPES OF LOWER EXTREMITY
AMPUTATION
partial foot amputation -amputation of the lower
limb distal to the ankle joint

ankle disarticulation - amputation of the lower

limb at the ankle joint

trans-tibial amputation - amputation of the lower

limb between the knee joint and the ankle joint,
commonly referred to as a below-knee amputation

knee disarticulation - amputation of the lower

limb at the knee joint
 CONT….

trans-femoral amputation - amputation of the

lower limb between the hip joint and the knee joint,
commonly referred to an above-knee amputation

hip disarticulation - amputation of the lower limb

at the hip joint

trans-pelvic disarticulation - amputation of the

whole lower limb together with all or part of the
pelvis, also known as a hemipelvectomy or
hindquarter amputation
 TYPES OF UPPER EXTREMITY
AMPUTATION
partial hand amputation
wrist disarticulation
trans-radial amputation, commonly referred to as
below-elbow or forearm amputation
elbow disarticulation
trans-humeral amputation, commonly referred to
as above-elbow amputation
shoulder disarticulation
 PROCEDURE

1. Remove the diseased tissue and any crushed

bone
2. Smooth uneven areas of bone
3. Seal off blood vessels and nerves
4. Cut and shape muscles so that the stump, or
end of the limb, will be able to have an artificial
limb (prosthesis) attached to it
 NURSING DIAGNOSIS
Impaired physical mobility related to loss of limb
as evidenced by decreased muscle strength
Disturbed body image related to absence of part
of body as evidenced by patient verbalization
Low self esteem related to loss of limb as
evidenced by negative feelings
Risk for infection
Risk for ineffective tissue perfusion
 NURSING CARE
Monitor vital signs. Palpate peripheral pulses,
noting strength and equality
Perform periodic neurovascular assessments
(sensation, movement, pulse, skin color, and
temperature).
Monitor laboratory studies: Hb and Hct
Administer low-dose anticoagulant as indicated.
Administer IV fluids and blood products as indicated
 Cont….
Inspect dressings and drainage device, noting
amount and characteristics of drainage
Provide stump care on a routine basis
Measure circumference periodically
Apply direct pressure to the bleeding site if
hemorrhage occurs.
If the patient experiences throbbing after the stump
is wrapped, the bandage may be too tight. Remove
the bandage and reapply
 Cont….
Encourage and assist with early ambulation.
Assist with specified ROM exercises for both the
affected and unaffected limbs beginning early in the
postoperative stage
Encourage active and isometric exercises for the
upper torso and unaffected limbs
Maintain knee extension. Provide trochanter rolls
as indicated.
Instruct patient to lie in the prone position as
tolerated at least twice a day with a pillow under the
abdomen and lower-extremity stump.
Apply antiembolic and sequential compression
hose to the non-operated leg, as indicated
 Cont….
Encourage expression of fears, negative feelings,
and grief over the loss of body part.
Ascertain individual strengths and identify
previous positive coping behaviors
Encourage participation in ADLs. Provide
opportunities to view and care for the stump, using
the moment to point out positive signs of healing
Encourage and provide for a visit by another
amputee, especially one who is successfully
rehabilitating.
Note withdrawn behavior, negative self-talk, use of 
denial, or over concern with actual and perceived
changes.
 Rehabilitation Goals
• Residual Limb Shrinkage and Shaping
• Limb Desensitization
• Maintain joint range of motion
• Strengthen residual limb
• Maximize self reliance
• Early prosthetic fitting
• Patient education: Future goals and
prosthetic options
 Amputation Outcomes
• Phantom limb pain is common

• Functionality and prosthetic use decreases with

more proximal amputations
• Reasons for revision amputations
– HO
– Infection
– Neuromas
– Contractures