An amputation is the surgical or traumatic separation of a body part from the body.1 It is estimated that one out of every 200 individuals in the United States has had an amputation.2 Medical conditions like peripheral vascular disease (PVD) account for most surgical amputations, which are most often planned procedures that occur within operative suites in healthcare facilities. In contrast, traumatic amputations are not planned and usually occur outside of the hospital setting. More than 30,000 traumatic amputations occur every year.3,4 This article focuses on traumatic amputations involving adult patients in the prehospital environment. EMS providers who are knowledgeable and well trained in the management of traumatic amputations may contribute significantly to the successful reattachment of amputated body parts and reducing patient morbidity and mortality.5
A traumatic amputation can involve any body part, including the arms, hands, fingers, legs, feet, toes, ears, nose, eyelids and genitalia. Upper limb amputations account for more than 65% of traumatic amputations.2 While anyone can be involved in an amputation, most victims are between ages 15 and 40. 2,3,6,7 A majority of the victims (80%) are male.3,7
The upper limbs include the fingers (phalanges), hand (metacarpals), wrist (carpals), forearm (radius/ulna), upper arm (humerus), shoulder blade (scapula) and collar bone (clavicle) (see Figures 1 and 2). Neurovascular structures include subclavian, axillary, brachial, radial, median and ulnar arteries. Axillary, radial, median and ulnar nerves are also present.8
Lower extremities include the pelvis (ilium, ischium, pubis), upper leg (femur, patella), lower leg (tibia/fibia) and foot (tarsals, metatarsals, phalanges) (see Figures 3 and 4). Neurovascular structures include the abdominal aorta, femoral, popliteal and anterior/posterior tibial arteries. Lower extremity nerves include sciatic, tibial and perineal.8
Amputations are either complete or incomplete (partial).5,6 In a complete amputation, there are no tissues, ligaments, muscles or other anatomical structures connecting the amputated part to the body. A partial amputation is one in which an anatomical structure, such as a ligament, tendon or muscle, is still intact between the body and the amputated anatomy. Although the body part may not be functional at the time and complete amputation may appear to be imminent, the body part is still connected to the body. In a partial amputation, every effort should be made to preserve this connection.
Amputations can involve proximal or distal anatomy. Proximal amputations involve anatomy that is attached closely to the body's core, such as an entire arm at the shoulder joint or a leg at the hip joint. Distal amputations involve anatomy that is distant from the core of the body, such as fingers or toes. Distal amputations are more common than proximal amputations.9,10
Specific phrases may be used when describing the anatomy involved in the amputation. For example, if the patient's leg is amputated below the knee, it may be referred to as a below-the-knee amputation, or "BKA." An amputation occurring above the knee may be referred to as above-the-knee amputation, or AKA.
Amputations can also be described according to their association with other injuries and the patient's condition. Simple amputations are those that do not involve extrication, shock is not present and additional injuries, such as multisystem trauma, are absent. Complex amputations are associated with complicated extrication, the presence of shock or the presence of additional injuries.
Mechanisms Of Amputation
There are numerous scenarios that can involve a traumatic amputation. Common examples include industrial, farming and motor vehicle accidents. The use of power equipment, including electric saws, lawn mowers and snow-blowers, also puts people at risk2,6,7,9,11 (see Tables I and II).