Limb amputation is one of the earliest forms of surgery, allowing a person to survive severe injuries and infections. Historically the main causes of amputation were trauma and wound infections. However in first world countries trauma is no longer the main cause of amputations because:
- Emergency medicine has greatly improved and more limbs are saved because a person can be transported to hospital quickly.
- Some amputated limbs can now be reattached with microsurgery.
- The number of workplace accidents have dropped significantly due to Health and Safety laws.
- Surgical sterilisation techniques and antibiotics control most infections.
In a modernised country such as Australia the main causes of amputations are vascular disease and diabetes. Other causes of amputation are traumatic injuries, infections, tumours and congenital deformities.
Vascular Disease: Vascular disease occurs when the arteries in the legs become blocked. This condition can happen to anyone but is more severe in patients with diabetes. The narrowed arteries prevent the heart from pumping enough oxygenated blood to the feet, resulting in severe pain in the legs, foot ulcerations and ultimately gangrene of the toes/foot.
Diabetes: Diabetes is the cause of half of the amputations performed in Queensland. Diabetes does not just increase the severity of vascular disease it also reduces feeling in the feet and slows wound healing; resulting in foot ulcers. People with diabetes are more prone to skin infections and gangrene or sepsis may occur, resulting in amputation.
Trauma: Trauma resulting in amputation is most frequently related to motorcycle, motor vehicle and industrial accidents.
Other causes are home accidents and burns. Most upper limb amputations are caused by traumatic injury. Trauma is the most common cause of amputation for young adults.
Infection: Infection as a cause of amputation occurs when bacteria, for example, Staphylococcus (Golden Staph) and meningococcal enter the body. These bacteria rapidly overwhelm the body resulting in severe infection, often with the patient unconscious and therefore unaware of the situation. The progression of the infection is rapid often resulting in multiple amputations to save the patient’s life.
Congenital defects: Children are sometimes born with missing or misshaped limb/s. The limb may form without a large bone making it too short or it may have extremities that have formed differently such as ‘nubbins’ instead of fingers/toes. To allow fitting of a prosthesis part of the limb may require amputation. Congenital defects are the most common causes of amputation in children.
Tumours: Bone cancer is a common cause of amputation. When a tumour does not respond well to conventional treatment it may be necessary to remove the affected tissue and bone to save the patient’s life. Limbsparing surgery is preferred but amputations are performed if the limb sparing surgery would result in a non functioning limb or the tumour is too difficult to remove without amputation.