Traumatic amputation refers to the loss of a body part that results due to having sustained an injury or accident. If amputations occur as a result of various disease, then the term ‘traumatic’ is understandably dropped, while others prefer terming the situation simply ‘limb loss’. Many amputees resort to using an artificial prosthesis to aid their recovery and return to a normal routine, though it is a fairly complicated process, which requires the patient to cope with both physically and emotionally demanding aspects.

 

The concept of phantom pain has been firstly observed by sixteenth century military physician, Ambrose Pare, who described the condition as being “the pain received by the region of the body no longer present”.  It used to be regarded as a psychological problem, but it has recently been proven that ‘real sensations’ do in fact occur in the spinal cord and brain.

Causes

Amputations:

Traumatic amputations are usually the result of an accident

 

Common accident sites: motor vehicle accidents, factory, farm and power tools accidents

 

Other unforeseeable events such as natural disasters and wars can also lead to traumatic amputations

 

Common non-traumatic causes:

 

Blood circulation – severe cases of atherosclerosis or diabetes may result in limb loss

 

Cancer

 

Birth-malformations

 

Phantom pain:

A specific factor responsible for the onset of phantom pain has not yet been found, but researchers speculate that at least partially, this sensation can be explained by a basic response of the body (pain) due to receiving mixed signals from the brain, in a process that is similar to a ‘re-mapping’ of the body’s sensory circuitry, the brain having to adjust to not being able to send and receive sensory information from a certain area of the body

 

Other contributing factors seem to be damaged nerve endings, scar tissue at the amputation site and the body’s own physical memory of pre-amputation pain

Symptoms and signs

Amputations:

A body part has been visibly completely or partially cut off

 

Bleeding may occur and it can be either minimal or severe, depending on type and site of the injury

 

Pain may also occur, but its severity is not necessarily related to the sustained injury

 

Crushed body tissue may also be present in the form of badly mangled flesh that is still partially attached to muscle, bone, tendon or skin

 

Phantom pain:

Early onset – the first few days after the amputation

 

Feelings of either coldness or warmth, itchiness or tingling

 

Pain seemingly feels to originate from the missing limb in the form of throbbing, shooting, squeezing or stabbing pain, and it may also be accompanied by a burning sensation

 

Sometimes it feels as if the phantom part is forced into an uncomfortable position

 

It may be a continuous sensation or it may give the impression of ‘coming and going’

Advice

Amputation:

In cases of traumatic amputations, before directly addressing the person’s amputation site, one should make sure that the wounded’s breathing and circulation are in order

 

Control bleeding by applying direct pressure to the wound and raise the injured area

 

If possible save any severed parts, remove foreign/dirty material that can further contaminate the wound

 

If possible, gently clean by rinsing with water the dry cut end of the severed part

 

Wrap the part in a clean, damp cloth, place it in a sealed plastic bag and only then place the bag into an ice water bath

 

Do not place the severed part directly onto ice, nor use dry ice since this will cause frostbite

 

If cold water is not at disposal, keep the detached part as far away from heat as possible

 

If the person has stable vital signs and does not exhibit more serious injuries (i.e. neck, back, head injuries) take the following steps to avoid the onset of shock: lay the person on the ground, raise their feet at about 12 inches and cover him/her with a blanket or coat to keep warm

 

Pain management includes both pharmacological and non-pharmacological means, depending on the type and severity of the injury

 

Residual limb pain occurs in the part of the limb after the amputation, various factors leading to this outcome: a poor prosthetic fit, bruising, rubbing of the skin (mechanical factors). Other non-mechanical factors include: ischemia (shortage of oxygen and blood to the heart muscle), heterotopic ossification (the abnormal presence of bone in soft tissue) or post-amputation neuroma (disorganized growth of nerve cells at a site of nerve injury)

 

Phantom pain:

Medications: antidepressants, anticonvulsants, narcotics and N-methyl-d-aspartate (NMDA) receptor antagonists that are usually prescribed in order to relieve pain caused by nerve damage, the latter ones working by inhibiting the action of glutamate, a protein playing a large role in the transmission of brain signals

 

Noninvasive therapies: nerve stimulation (transcutaneous electrical nerve stimulation) to prevent electrical signals from reaching the brain (and therefore putting a halt to the brain’s further relaying the message of ‘pain’ back to the body), mirror boxing (attaching a device constructed of two mirrors so that the patient can watch himself/herself perform symmetrical actions as if having the limb) and acupuncture

 

Minimally invasive therapies: injecting local anesthetics or steroids and spinal cord stimulation through electrodes placed along the patient’s spinal cord

 

Surgery: brain stimulation via an MRI scan to position the electrodes correctly and stump revision (neurectomy), though the procedure may result in worsening the feeling of pain

MISCONCEPTIONS
  • Amputees are always very sensitive when asked about their prosthesis

     

    A traumatic accident must have been the cause

     

    A normal life with its normal activities can never be resumed

     

    Phantom pain is the same as stump pain (the latter one occurs in the tissue surrounding the amputation site, which can be damaged to various degrees)

Statistics

Dillingham et. al (2002) – overall rates of amputation due to trauma or malignancy are decreasing while dysvascular (defective blood supply) amputations are increasing

 

World Health Organization multinational study of vascular diseases in diabetes – an incidence of lower limb amputation is higher in the American Indian centers than in the East Asian ones (Chaturvedi et. al 2001)

 

The 2001 Haitian earthquake is a natural disasters that ended up causing one of the largest numbers of amputations in history

 

Lower limb amputations seem to be more common than upper losses of limb and are usually due to diseases not traumas

 

In a study of male veterans with amputations due to either critical limb ischemia or diabetes who underwent rehabilitation at 17 months follow-up, 29% were able to ambulate outdoors, 25% ambulated indoors only, and 46% were nonambulatory. Only 42% were using prosthetic limbs*

 

The World Health Organization estimates that in Latin America, Africa, and Asia combined, almost 30 million people require prosthetic limbs, braces, or other devices, up from 24 million in 2006 (Aleccia 2010) *

 

The incidence of phantom limb pain has been reported to range from 42.2 to 78.8% in amputees**

 

 

Did you know?

A tourniquet is a special constricting device specifically constructed in order to control the blood flow to an extremity for longer periods of time

 

Phantom pain may also be triggered by pressure on the remaining part of the limb or by emotional stress

 

Though phantom pain has been reported to have occurred mostly in patients that have had either a hand or a leg amputated, there have also been cases of the disorder’s onset after the removal of other parts of the body too, namely breast, penis, eye or tongue