Limb Amputation

This book opens with a unique historical review of natural amputations due to congenital absence, disease, frostbite, animal trauma, and to punishment and ritual. The advent of surgical amputation and its difficulties form a major part of the book, summarising the evolution of the control of haemorrhage and infection, pain relief, techniques, instrumentation, complications, prostheses, results and case histories. Alternative procedures, increasingly important in the last two centuries, are also debated.

The majority of amputations in the western world today are due to vascular disease. Despite the advances in surgical treatment of this disease, particularly by reconstruction, it is a sad fact that the number of amputations performed in these countries each year for vascular disease is increasing. Most of these amputees are elderly and their life expectancy is short, so it is important that the treatment and rehabilitation that they receive is informed, appropriate, efficient and swift to enable them to return successfully to life in the community for their remaining years. Management of this group of patients has proved to be successful only if a multidisciplinary team approach is adopted. Until recently in the UK, this approach sadly has only been implemented by a few centres. However, with the publication of the McColl report into the prosthetic and wheelchair service in 1986, interest in the care of the amputee is growing throughout the country. This book covers all aspects of amputation from disease and diagnosis to rehabilitation and community discharge with emphasis on the man agerneut of the largest group, the vascular lower limb amputee. A team approach is described and emphasized as being essential for good results and subsequent successful return into the community. The role of each of the important disciplines is described in relation to the appropriate part of the rehabilitation phase.

Implement TMR with Your Patients and Improve Their Quality of Life Developed by Dr. Todd A. Kuiken and Dr. Gregory A. Dumanian, targeted muscle reinnervation (TMR) is a new approach to accessing motor control signals from peripheral nerves after amputation and providing sensory feedback to prosthesis users. This practical approach has many advantages over other neural-machine interfaces for the improved control of artificial limbs. Targeted Muscle Reinnervation: A Neural Interface for Artificial Limbs provides a template for the clinical implementation of TMR and a resource for further research in this new area of science. After describing the basic scientific concepts and key principles underlying TMR, the book presents surgical approaches to transhumeral and shoulder disarticulation amputations. It explores the possible role of TMR in the prevention and treatment of end-neuromas and details the principles of rehabilitation, prosthetic fitting, and occupational therapy for TMR patients. The book also describes transfer sensation and discusses the surgical and functional outcomes of the first several TMR patients. It concludes with emerging research on using TMR to further improve the function and quality of life for people with limb loss. With contributions from renowned leaders in the field, including Drs. Kuiken and Dumanian, this book is a useful guide to implementing TMR in patients with high-level upper limb amputations. It also supplies the foundation to enable improvements in TMR techniques and advances in prosthetic technology.

The main objective in the rehabilitation of people following amputation is to restore or improve their functioning, which includes their return to work. Full-time employment leads to beneficial health effects and being healthy leads to increased chances of full-time employment (Ross and Mirowskay 1995). Employment of disabled people enhances their self-esteem and reduces social isolation (Dougherty 1999). The importance of returning to work for people following amputation the- fore has to be considered. Perhaps the first article about reemployment and problems people may have at work after amputation was published in 1955 (Boynton 1955). In later years, there have been sporadic studies on this topic. Greater interest and more studies about returning to work and problems people have at work following amputation arose in the 1990s and has continued in recent years (Burger and Marinc ?ek 2007). These studies were conducted in different countries on all the five continents, the greatest number being carried out in Europe, mainly in the Netherlands and the UK (Burger and Marinc ?ek 2007). Owing to the different functions of our lower and upper limbs, people with lower limb amputations have different activity limitations and participation restrictions compared to people with upper limb amputations. Both have problems with driving and carrying objects. People with lower limb amputations also have problems standing, walking, running, kicking, turning and stamping, whereas people with upper limb amputations have problems grasping, lifting, pushing, pulling, writing, typing, and pounding (Giridhar et al. 2001).

Each year in the United States, an estimated 40,000 persons lose a limb. Of these amputees, approximately 30% lose a hand or an arm. This loss is most frequently related to trauma occurring in the healthy young adult male and is often work related. Approximately 3% of all amputees are born with congenital limb absence. In children, the ratio of congenital to acquired amputation is 2: 1, and the ratio of upper-limb to lower-limb amputees is 1. 2: 1. Therefore, since relatively few amputations result in upper-limb loss, only a small number of health practitioners, even those specializing in amputee rehabilitation, have the opportunity to provide services for a significant number of arm amputees. As a result, clinicians need to share their experiences so that the full range of options for optimum care and rehabilitation of the patient population may be considered. To meet this challenge for wider communication of clinical experience, a group of upper-limb amputee specialists met in Houston, Texas, in 1981 to serve as the core faculty for a course entitled "Contemporary Issues in Upper Extremity Amputation and Prosthetic Function. " This program provided the opportunity for surgeons, physiatrists, engineers, prosthetists, social workers, psychologists, occupational therapists, and physical therapists from the United States and Canada to discuss their extensive experience in working with upper extremity amputees. A second conference continuing the discussion of upper limb amputee rehabilitation was held one year later.

Limb loss can occur due to trauma, infection, diabetes, vascular disease, cancer, and other diseases. Regardless of the cause, it often has a profound impact on a person's life. Many amputees experience feelings of loss and grief, frustration in learning to walk with an artificial limb, and difficulty adjusting to a new and challenging lifestyle. This book provides the practical knowledge needed to cope with the many changes caused by lower limb amputation. In clear, accessible language, it covers the medical, physical, and psychosocial issues and answers crucial questions such as: How do I cope emotionally with the loss of a limb? What steps can I take to prevent additional amputations? How do I treat and care for my post-surgery wound? What are the best prostheses for my particular needs? Can I play sports and exercise with a prosthesis? And much more! This unique resource aims to educate those with lower limb amputation so that they can better care for themselves and maximize their independence. The practical advice, tips, and extensive references within its pages will help individuals meet the challenges of leading full and fruitful lives.

Limb loss can occur due to trauma, infection, diabetes, vascular disease, cancer and other diseases. Lower limb amputation is relatively common and has a profound impact on a person's life, regardless of the cause. Feelings of loss and grief, difficulties in learning to walk with an artificial limb, and readjustment to an interrupted life all pose considerable challenges. Nevertheless, there are countless stories of people who have successfully overcome these problems. This book provides the practical knowledge needed to cope with the life changes caused by lower limb amputation. It demystifies the medical process and technical jargon by using plain, easily understandable language. And it is the first book to combine medical, prosthetic, and psychosocial factors in one convenient volume, including: Causes of lower limb amputation, especially diabetes, and ways to prevent further amputation Surgical techniques for lower limb amputation Learning to walk with a prosthesis The unique challenges faced by children and elderly people living with an amputation Exercising and sports with a lower limb prosthesis And much more! The outlook of this book is ultimately an optimistic one. Well-informed, knowledgeable individuals with amputations are better able to take care of themselves and are more effective self-advocates. This book gives them the tools they need to forge a productive, satisfying, and high-quality life.