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Traumatic amputation

Definition

Traumatic amputation is the loss of a body part, usually a finger, toe, arm, or leg, that occurs as the result of an accident or injury.

Considerations

If an accident or trauma results in complete amputation (the body part is totally severed), the part sometimes can be reattached, often when proper care is taken of the severed part and stump, or residual limb.

In a partial amputation, some soft-tissue connection remains. Depending on how severe the injury is, the partially severed extremity may or may not be able to be reattached.

Complications often occur when a body part is amputated. The most important of these are bleeding, shock, phantom pain and infection.

The long-term outcome for an amputee depends on early emergency and critical care management. A well-fitting and functional prosthesis and retraining can speed rehabilitation.

Causes

Traumatic amputations usually result from factory, farm, power tool accidents, or from motor vehicle accidents. Natural disasters, war, and terrorist attacks can also cause traumatic amputations.

Symptoms

Symptoms may include:

• Bleeding (may be minimal or severe, depending on the location and nature of the injury)

• Pain (the degree of pain is not always related to the severity of the injury or the amount of bleeding)

• Crushed body tissue (badly mangled, but still partially attached by muscle, bone, tendon, or skin)

First Aid

Steps to take:

• Check the person's airway (open if necessary); check breathing and circulation. If necessary, begin rescue breathing, cardiopulmonary resuscitation (CPR), or bleeding control.

• Call for medical help.

• Try to calm and reassure the person as much as possible. Amputation is painful and very frightening.

• Control bleeding by applying direct pressure to the wound. Raise the injured area. If bleeding continues, recheck the source of the bleeding and reapply direct pressure, with help from someone who is not tired. If the person has life-threatening bleeding, a tight bandage or tourniquet will be easier to use than direct pressure on the wound. However, using a tight bandage for a long time may do more harm than good.

• Save any severed body parts and make sure they stay with the person. If possible, remove any dirty material that can contaminate the wound, then gently rinse the body part if the cut end is dirty.

• Wrap the severed part in a clean, damp cloth, place it in a sealed plastic bag and place the bag in an ice water bath.

• Do not put the body part directly in water or ice without using a plastic bag.

• Do not put the severed part directly on ice. Do not use dry ice as this will cause frostbite and injury to the part.

• If cold water is not available, keep the part away from heat as much as possible. Save it for the medical team, or take it to the hospital. Cooling the severed part allows a longer window of time for later reattachment. Without cooling, the severed part is only good for reattachment for about 4 to 6 hours.

• Keep the person warm and calm.

• Take steps to prevent shock. Lay the person flat, raise the feet about 12 inches (30 centimeters), and cover the person with a coat or blanket. Do not place the person in this position if a head, neck, back, or leg injury is suspected or if it makes the victim uncomfortable.

• Once the bleeding is under control, check the person for other signs of injury that require emergency treatment. Treat fractures, additional cuts, and other injuries appropriately.

• Stay with the person until medical help arrives.

Do Not

• Do not forget that saving the person's life is more important than saving a body part.

• Do not overlook other less obvious injuries.

• Do not attempt to push any part or bone back into place.

• Do not decide that a body part is too small to save.

• Do not place a tourniquet, unless the bleeding is life threatening, as the entire limb may be harmed.

• Do not raise false hopes of reattachment.

When to Contact a Medical Professional

If someone severs a limb, finger, toe, or other body part, you should call right away for emergency medical help.

Prevention

Use safety equipment when using factory, farm, or power tools. Wear seat belts when driving a motor vehicle. Always use good judgment and observe appropriate safety precautions.

References

American Academy of Orthopaedic Surgeons website. Fingertip injuries and amputations. orthoinfo.aaos.org/en/diseases--conditions/fingertip-injuries-and-amputations. Reviewed May 2022. Accessed August 30, 2024.

Rose E. Management of amputations. In: Roberts JR, Custalow CB, Thomsen TW, eds. Roberts & Hedges' Clinical Procedures in Emergency Medicine and Acute Care. 7th ed. Philadelphia, PA: Elsevier; 2019:chap 47.

Switzer JA, Bovard RS, Quinn RH. Wilderness orthopedics. In: Auerbach PS, Cushing TA, Harris NS, eds. Auerbach's Wilderness Medicine. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 22.

Review Date: 8/27/2024

Reviewed By: C. Benjamin Ma, MD, Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.