{{Short description|Medical procedure that removes a part of the body}} {{Use mdy dates|date=April 2025}} {{Infobox medical condition | name = Amputation | image = Flickr_-_The_U.S._Army_-_U.S._Army_World_Class_Athlete_Program_Paralympic.jpg | caption = An amputee running with a blade prosthetic | pronounce = | field = [[Surgery]] [[Physical medicine and rehabilitation]] [[Emergency medicine]] | symptoms = | complications = [[Phantom limb syndrome]] | onset = | duration = | types = | causes = [[Major trauma|Trauma]] or intentional as part of [[surgery]] and sometimes [[corporal punishment]] | risks = | diagnosis = | differential = | prevention = | treatment = | medication = | prognosis = | frequency = | deaths = |alt=}} {{corporal punishment}} {{Criminal procedure (trial)}}
'''Amputation''' is the removal of a [[Limb (anatomy)|limb]] or other body part by [[Physical trauma|trauma]], [[medical illness]], or [[surgery]]. As a surgical measure, it is used to control pain or a disease process in the affected limb, such as [[cancer|malignancy]] or [[gangrene]]. In some cases, it is carried out on individuals as a [[Preventive healthcare|preventive surgery]] for such problems. A special case is that of [[congenital amputation]], a [[congenital disorder]], where [[fetus|fetal]] limbs have been cut off by constrictive bands. In some countries, judicial amputation is currently used [[punishment|to punish]] people who commit crimes.<ref name="iran">{{Cite news |last=Fathi |first=Nazila |date=2008-01-11 |title=Spate of Executions and Amputations in Iran |work=[[The New York Times]] |url=https://www.nytimes.com/2008/01/11/world/middleeast/11iran.html |url-access=limited |access-date=2021-06-27}}</ref><ref name="Chuback 2005">{{Cite conference |last=Chuback |first=Jennifer E. |date=March 2005 |editor-last=Whitelaw |editor-first=W. A. |title=The history of rhinoplasty |url=https://www.researchgate.net/publication/16854023 |conference=14th Annual History of Medicine Days |publisher=[[University of Calgary]] |publication-place=Calgary, Alberta, Canada |pages=10–15 |via=[[ResearchGate]]}}</ref><ref>{{Cite journal|last=Kocharkarn|first=Wachira | name-list-style = vanc |date=Summer 2000|title=Traumatic amputation of the penis|url=http://brazjurol.com.br/pdf/kochakarn_385_389.pdf |archive-url=https://ghostarchive.org/archive/20221009/http://brazjurol.com.br/pdf/kochakarn_385_389.pdf |archive-date=2022-10-09 |url-status=live|journal=Brazilian Journal of Urology|volume=26|pages=385–389|via=Official Journal of the Brazilian Society of Urology}}</ref><ref>{{Cite book|url=https://books.google.com/books?id=Im95I7FjrvwC&q=amputation+punishment&pg=PR7|title=Crime and Punishment in Islamic Law: Theory and Practice from the Sixteenth to the Twenty-First Century|last=Peters|first=Rudolph| name-list-style = vanc |date=2005|publisher=Cambridge University Press|isbn=978-0-521-79226-4 }}</ref> Amputation has also been used as a tactic in war and acts of terrorism; it may also occur as a war injury. In some cultures and religions, minor amputations or [[mutilation]]s are considered a ritual accomplishment.<ref>{{cite journal | vauthors = Bosmia AN, Griessenauer CJ, Tubbs RS | title = Yubitsume: ritualistic self-amputation of proximal digits among the Yakuza | journal = Journal of Injury and Violence Research | volume = 6 | issue = 2 | pages = 54–56 | date = July 2014 | pmid = 24284812 | pmc = 4009169 | doi = 10.5249/jivr.v6i2.489 }}</ref><ref>{{cite journal | vauthors = Kepe T | title = 'Secrets' that kill: crisis, custodianship and responsibility in ritual male circumcision in the Eastern Cape Province, South Africa | journal = Social Science & Medicine | volume = 70 | issue = 5 | pages = 729–735 | date = March 2010 | pmid = 20053494 | doi = 10.1016/j.socscimed.2009.11.016 }}</ref><ref>{{cite journal | vauthors = Grisaru N, Lezer S, Belmaker RH | title = Ritual female genital surgery among Ethiopian Jews | journal = Archives of Sexual Behavior | volume = 26 | issue = 2 | pages = 211–215 | date = April 1997 | pmid = 9101034 | doi = 10.1023/a:1024562512475 | s2cid = 32053425 }}</ref> When done by a person, the person executing the amputation is an amputator.<ref>{{Cite encyclopedia |title=Amputator |encyclopedia=[[Merriam-Webster]] |url=https://www.merriam-webster.com/dictionary/amputator |access-date=28 June 2021}}</ref><ref>{{Cite encyclopedia |title=Amputee |encyclopedia=[[Merriam-Webster]] |url=https://www.merriam-webster.com/dictionary/amputee |access-date=28 June 2021}}</ref> The oldest evidence of this practice comes from a skeleton found buried in Liang Tebo cave, [[East Kalimantan]], Indonesian [[Borneo]] dating back to at least 31,000 years ago, where it was done when the amputee was a young child.<ref>{{cite journal|last1=Maloney|first1=T.R.|last2=Dilkes-Hall|first2=I.E.|last3=Vlok|first3=M|title=Surgical amputation of a limb 31,000 years ago in Borneo|journal=Nature|issue=7927|pages=547–551|year=2022|volume=609 |doi=10.1038/s41586-022-05160-8|pmid=36071168 |pmc=9477728 |bibcode=2022Natur.609..547M }}</ref> A [[prosthesis]] or a [[Bioelectronics|bioelectric replantation]] may restore sensation of the amputated limb.
==Types== {{more citations needed section|date=June 2021}}
=== Leg === Lower limb amputations can be divided into two broad categories: minor and major amputations. Minor amputations generally refer to the amputation of [[toe|digits]]. Major amputations are commonly below-knee- or above-knee amputations. Common partial foot amputations include the [[François Chopart|Chopart]], [[Tarsometatarsal articulations|Lisfranc]], and ray amputations.
Common forms of ankle [[disarticulation]]s include Pyrogoff, Boyd, and Syme amputations.<ref>{{cite journal | vauthors = Pinzur MS, Stuck RM, Sage R, Hunt N, Rabinovich Z | title = Syme ankle disarticulation in patients with diabetes | journal = The Journal of Bone and Joint Surgery. American Volume | volume = 85 | issue = 9 | pages = 1667–72 | date = September 2003 | pmid = 12954823 | doi = 10.2106/00004623-200309000-00003 }}</ref> A less common major amputation is the [[Van Nes rotation]], or rotationplasty, i.e. the turning around and [[replantation|reattachment]] of the foot to allow the ankle joint to take over the function of the knee.
Types of amputations include: [[File:Diagram showing an above knee amputation CRUK 094.svg|thumb|upright=1.1|An above-knee amputation]] ; partial foot amputation: amputation of the lower limb distal to the ankle joint ; ankle disarticulation: amputation of the lower limb at the ankle joint ; {{anchor|BTK}}trans-tibial amputation: amputation of the lower limb between the knee joint and the ankle joint, commonly referred to as a below-knee amputation ; {{anchor|BKA}}knee disarticulation: amputation of the lower limb at the knee joint ; trans-femoral amputation: amputation of the lower limb between the hip joint and the knee joint, commonly referred to an above-knee amputation ; hip disarticulation: amputation of the lower limb at the hip joint ; trans-pelvic disarticulation: amputation of the whole lower limb together with all or part of the pelvis, also known as a [[hemipelvectomy]] or hindquarter amputation
===Arm=== [[File:Amputations 18c.jpg|thumb|250px|The 18th century guide to amputations]]Types of upper extremity amputations include: * partial hand amputation * wrist disarticulation * trans-radial amputation, commonly referred to as below-elbow or forearm amputation * elbow disarticulation * trans-humeral amputation, commonly referred to as above-elbow amputation * shoulder disarticulation * [[forequarter amputation]] A variant of the trans-radial amputation is the [[Krukenberg procedure]] in which the radius and ulna are used to create a stump capable of a pincer action.
===Other=== [[File:Index finger amputation.jpg|thumb|Partial amputation of [[index finger]]]] * Facial amputations include but are not limited to: ** amputation of the ears ** amputation of the nose ([[rhinotomy]]) ** amputation of the tongue ([[glossectomy]]) ** amputation of the eyes ([[enucleation of the eye|enucleation]]) ** amputation of the teeth ([[Dental evulsion]]). Removal of teeth, mainly incisors, is or was practiced by some cultures for ritual purposes (for instance in the [[Iberomaurusian]] culture of [[Prehistoric Central North Africa|Neolithic North Africa]]). * Breasts: ** amputation of the breasts ([[mastectomy]]) * [[Genitals]]: ** amputation of the testicles ([[orchiectomy]]) ** amputation of the penis ([[penectomy]]) ** amputation of the [[foreskin]] ([[circumcision]]) ** amputation of the clitoris ([[clitoridectomy]]) ** amputation of the vulva ([[vulvectomy]]) * Radicals: ** Amputation of the waist ([[hemicorporectomy]]) ** Amputation of the head ([[decapitation]])
[[Genital modification and mutilation]] may involve amputating tissue, although not necessarily as a result of injury or disease.
[[Laryngectomy]] is the amputation of the larynx.
===Self-amputation=== In some rare cases when a person has become trapped in a deserted place, with no means of communication or hope of rescue, the victim has amputated their own limb. The most notable case of this is [[Aron Ralston]], a hiker who amputated his own right forearm after it was pinned by a boulder in a hiking accident and he was unable to free himself for over five days.<ref>{{Cite news |last=Ransom |first=Cliff |date=24 July 2003 |title=Did Climber Have to Cut Off Arm to Save Life? |work=National Geographic |url=https://www.nationalgeographic.com/culture/article/climber-ralston-amputate-arm-utah/ |archive-url=https://web.archive.org/web/20190106010831/https://www.nationalgeographic.com/culture/2003/07/climber-ralston-amputate-arm-utah/ |archive-date=January 6, 2019 |access-date=5 January 2019}}</ref>
[[Body integrity dysphoria]] is a rare condition in which an individual feels compelled to remove one or more of their body parts, usually a limb. In some cases, that individual may take drastic measures to remove the offending appendages, either by causing irreparable damage to the limb so that medical intervention cannot save the limb, or by causing the limb to be severed.<ref>{{Cite journal |last=Müller |first=Sabine |date=2009-01-05 |title=Body Integrity Identity Disorder (BIID)—Is the Amputation of Healthy Limbs Ethically Justified? |url=http://www.tandfonline.com/doi/abs/10.1080/15265160802588194 |journal=The American Journal of Bioethics |language=en |volume=9 |issue=1 |pages=36–43 |doi=10.1080/15265160802588194 |pmid=19132621 |issn=1526-5161|url-access=subscription }}</ref>
===Urgent=== In [[surgery]], a '''guillotine amputation''' is an amputation performed without closure of the skin in an urgent setting.<ref name=GuilAnk>{{cite journal|last1=Panchbhavi|first1=Vinod K|title=Guillotine Ankle Amputation|url=http://emedicine.medscape.com/article/1894411-overview|website=Medscape|date=8 June 2021}}</ref> Typical indications include catastrophic trauma or infection control in the setting of [[infected gangrene]].<ref name=GuilAnk/> A guillotine amputation is typically followed by a more time-consuming, definitive amputation such as an [[above knee amputation|above or below knee amputation]].<ref name=GuilAnk/>
==Causes==
===Circulatory disorders=== * [[Diabetes|Diabetic]] vasculopathy * [[Sepsis]] with peripheral necrosis * [[Peripheral artery disease]] which can lead to [[gangrene]] * A severe [[deep vein thrombosis]] ([[phlegmasia cerulea dolens]]) can cause [[compartment syndrome]] and gangrene<ref name=Compartment>{{cite journal | vauthors = Abdul W, Hickey B, Wilson C | title = Lower extremity compartment syndrome in the setting of iliofemoral deep vein thrombosis, phlegmasia cerulea dolens and factor VII deficiency | journal = BMJ Case Reports | volume = 2016 | date = April 2016 | pages = bcr2016215078 | pmid = 27113791 | pmc = 4854131 | doi = 10.1136/bcr-2016-215078 }}</ref>
===Neoplasm=== [[Image:1daypost.jpg|thumb|right|Transfemoral amputation due to [[liposarcoma]]]] * Cancerous bone or soft tissue tumors (e.g. [[osteosarcoma]], [[chondrosarcoma]], [[fibrosarcoma]], [[epithelioid sarcoma]], [[Ewing's sarcoma]], [[synovial sarcoma]], [[sacrococcygeal teratoma]], [[liposarcoma]]), [[melanoma]]<ref>{{Citation |last1=Ragnarsson |first1=Kristjan T. |title=Cancer of the Limbs |date=2003 |url=https://www.ncbi.nlm.nih.gov/books/NBK13778/ |work=Holland-Frei Cancer Medicine. 6th edition |access-date=2024-01-09 |publisher=BC Decker |language=en |last2=Thomas |first2=David C.}}</ref>
===Trauma=== [[Image:World War I radiography amputee.jpg|thumb|Three fingers from a soldier's right hand were traumatically amputated during [[World War I]].]] * Severe limb [[injury|injuries]] in which the efforts to save the limb fail or the limb cannot be saved. * [[Physical trauma|Traumatic]] amputation (an unexpected amputation that occurs at the scene of an accident, where the limb is partially or entirely severed as a direct result of the accident, for example, a finger that is severed from the blade of a table saw) * Amputation in utero ([[Amniotic band]])
===Congenital anomalies=== * Deformities of digits and/or limbs (e.g., [[proximal femoral focal deficiency]], [[Fibular hemimelia]]) * Extra digits and/or limbs (e.g., [[polydactyly]])
===Infection=== {{columns-list|colwidth=25em| * [[Animal bite]]s * [[Bubonic plague]] * [[Diabetic foot infection]]s * [[Gangrene]] * [[Gas gangrene]] * [[Influenza A Virus]] * ''[[Legionella]]'' * [[Meningococcal meningitis]] * [[Necrosis]] * [[Necrotizing fasciitis]] * [[Osteomyelitis]] (bone infection) * [[Sepsis]] * ''[[Streptococcus]]'' * [[Trench foot]] * ''[[Vibrio vulnificus]]'' }}
=== Frostbite ===
[[Frostbite]] is a cold-related injury occurring when an area (typically a limb or other extremity)<ref>{{Cite web |date=2017-10-19 |title=Frostbite |url=https://www.nhs.uk/conditions/frostbite/ |access-date=2022-06-29 |website=nhs.uk |language=en}}</ref> is exposed to extreme low temperatures, causing the freezing of the skin or other tissues.<ref name="handford2017">{{Cite journal |last1=Handford |first1=Charles |last2=Thomas |first2=Owen |last3=Imray |first3=Christopher H. E. |date=2017-05-01 |title=Frostbite |url=https://www.sciencedirect.com/science/article/pii/S0733862716301201 |journal=Emergency Medicine Clinics of North America |series=Wilderness and Environmental Medicine |language=en |volume=35 |issue=2 |pages=281–299 |doi=10.1016/j.emc.2016.12.006 |pmid=28411928 |issn=0733-8627|url-access=subscription }}</ref> Its [[pathophysiology]] involves the formation of ice crystals upon freezing and [[blood clot]]s upon thawing, leading to [[cell damage]] and [[cell death]].<ref name="handford2017" /> Treatment of severe frostbite may require surgical amputation of the affected tissue or limb;<ref>{{Cite journal |last1=Handford |first1=Charles |last2=Buxton |first2=Pauline |last3=Russell |first3=Katie |last4=Imray |first4=Caitlin Ea |last5=McIntosh |first5=Scott E. |last6=Freer |first6=Luanne |last7=Cochran |first7=Amalia |last8=Imray |first8=Christopher He |date=2014 |title=Frostbite: a practical approach to hospital management |journal=Extreme Physiology & Medicine |volume=3 |article-number=7 |doi=10.1186/2046-7648-3-7 |issn=2046-7648 |pmc=3994495 |pmid=24764516 |doi-access=free }}</ref> if there is deep injury [[autoamputation]] may occur.<ref>{{Cite web |title=Frostbite Clinical Presentation: History, Physical Examination, Complications |url=https://emedicine.medscape.com/article/926249-clinical |access-date=2022-06-29 |website=emedicine.medscape.com}}</ref>
===Athletic performance=== Sometimes professional [[Sportsperson|athletes]] may choose to have a non-essential digit amputated to relieve chronic pain and impaired performance. * Australian Rules footballer [[Daniel Chick]] elected to have his left [[ring finger]] amputated as chronic pain and injury was limiting his performance.<ref>{{Cite web |last=Murray |first=Shane |date=2002-01-22 |title=RTE: Aussie Rules star has finger removed |website=[[RTÉ.ie]] |url=http://www.rte.ie/sport/2002/0122/aussierules.html |archive-url=https://web.archive.org/web/20071214022643/http://www.rte.ie/sport/2002/0122/aussierules.html |archive-date=2007-12-14 |access-date=2007-10-19}}</ref> * [[Rugby union]] player [[Jone Tawake]] also had a finger removed.<ref>{{cite web |author=Australian Rugby Union |url=http://www.sportsaustralia.com/articles/oct06/artid6659.html |title=Tawake undergoes surgery to remove finger |publisher=SportsAustralia.com |date=2006-10-17 |access-date=2013-04-22 |archive-url=https://web.archive.org/web/20130501093242/http://sportsaustralia.com/articles/oct06/artid6659.html |archive-date=2013-05-01 }}</ref> * [[National Football League]] [[Safety (American and Canadian football position)|safety]] [[Ronnie Lott]] had the tip of his little finger removed after it was damaged in the [[1985 NFL season]].<ref>{{Cite magazine|magazine=[[Sports Illustrated]]|title=Ronnie Lott's Amputated Pinkie Finger|first=Robert|last=Klemko|url=https://www.si.com/nfl/2014/06/17/nfl-history-in-95-objects-ronnie-lott-amputated-pinkie-finger|date=2014-06-17|archive-url=https://web.archive.org/web/20220815042211/https://www.si.com/nfl/2014/06/17/nfl-history-in-95-objects-ronnie-lott-amputated-pinkie-finger|archive-date=2022-08-15}}</ref>
=== Criminal penalties === {{anchor|Criminal penalty}} * According to [[Quran 5:38]], the punishment for stealing is the amputation of the hand. Under [[Sharia law]], after repeated offense, the foot may also be cut off. This is still in practice today in countries like [[Brunei]], the [[United Arab Emirates]],<ref>{{Cite web|title=Burglar's hand to be amputated|url=https://gulfnews.com/uae/crime/burglars-hand-to-be-amputated-1.343257|access-date=2021-11-03|website=Gulf News|date=30 December 2004 |language=en}}</ref> [[Iran]],<ref>{{Cite news |date=2010-10-17 |title=Iranian chocolate thief faces hand amputation |work=[[BBC News Online]] |url=https://www.bbc.com/news/world-middle-east-11559750 |access-date=2021-06-28}}</ref><ref name="Telegraph 2008">{{Cite news |last=Dovan |first=Fiona |date=2008-02-09 |title=Iran envoy defends amputation |work=[[The Daily Telegraph|The Telegraph]] |url=https://www.telegraph.co.uk/news/worldnews/1578146/Iran-envoy-defends-amputation.html |url-access=limited |access-date=2021-06-28}}</ref> [[Saudi Arabia]],<ref name="MC 2007">{{Cite news |date=2007-11-05 |title=Saudi Arabia chops off hand of Egyptian for theft |work=Monsters and Critics |url=http://www.monstersandcritics.com/news/middleeast/news/article_1371270.php/Saudi_Arabia_chops_off_hand_of_Egyptian_for_theft |access-date=2021-06-27 |archive-url=https://web.archive.org/web/20100811044139/http://www.monstersandcritics.com/news/middleeast/news/article_1371270.php/Saudi_Arabia_chops_off_hand_of_Egyptian_for_theft |archive-date=2010-08-11}}</ref> [[Yemen]],<ref>{{Cite web|date=2013-09-16|title=Yemeni man sentenced to hand and foot amputation for armed robbery|url=https://www.amnesty.org/en/latest/press-release/2013/09/yemeni-man-sentenced-hand-and-foot-amputation-armed-robbery/|access-date=2021-11-03|publisher=Amnesty International|language=en}}</ref> and 11 of the 36 states within [[Nigeria]].<ref>{{Cite news |last=Bamford |first=David |date=2001-07-01 |title=Hand amputation in Nigeria |work=[[BBC News]] |url=http://news.bbc.co.uk/2/hi/africa/1428159.stm |access-date=2021-06-28}}</ref><ref>{{Cite news |last=Bello |first=Ademola |date=2010-06-11 |title=Who Will Save Amputees of Sharia Law in Nigeria? |work=[[Huffington Post]] |url=https://www.huffpost.com/entry/who-will-save-amputees-of_b_532949 |access-date=2021-06-28}}</ref> * '''[[Cross-amputation]]''' is one of the [[Hudud]] punishments prescribed under [[Fiqh|Islamic jurisprudence]] (Sharia law) and involves cutting off the right hand and left foot of the alleged transgressor.<ref>{{Cite web |last=Tarabella |first=Marc |title=Parliamentary question {{!}} VP/HR - Cross-amputation in Yemen {{!}} E-011050/2013 |publisher=European Parliament |url=https://www.europarl.europa.eu/doceo/document/E-7-2013-011050_EN.html |access-date=2023-08-07 |language=en}}</ref><ref>{{Cite book |last=Peters |first=Rudolph |url=https://books.google.com/books?id=Im95I7FjrvwC |title=Crime and Punishment in Islamic Law: Theory and Practice from the Sixteenth to the Twenty-First Century |date=2005 |publisher=Cambridge University Press |isbn=978-0-521-79226-4 |page=166 |language=en}}</ref> The scriptural authority for the double amputation procedure is in the [[Quran]] (''surah'' 5.33–34) which stipulates:{{blockquote|The punishment of those who wage war against Allah and His Messenger, and strive with might for mischief through the land is execution or crucifixion, or cutting of hands and feet from opposite sides, or exile from the land. As for the thief, male or female, cut off their hands and feet from opposite ends in recompense for what they have committed.<ref>{{cite web |title=The Quran, sura 5, verse 33 |url=https://www.perseus.tufts.edu/hopper/text?doc=Perseus%3Atext%3A2002.02.0006%3Asura%3D5%3Averse%3D33 |website=Perseus Project|publisher=Tufts University}}</ref>}} The severe [[punishment]], for "highway robbery (''[[hirabah]]'', ''qat' al-tariq'') and civil disturbance against Islam", is usually carried out in a single session in public, without anaesthetic and using a sword. The ancient punishment is practised in Islamic countries such as Saudi Arabia,<ref>{{Cite web |date=2011-12-16 |title=Saudi Arabia: King urged to commute 'cross amputation' sentences |url=https://www.amnesty.org/en/latest/press-release/2011/12/saudi-arabia-king-urged-commute-cross-amputation-sentences/ |access-date=2023-08-07 |publisher=Amnesty International |language=en}}</ref> Sudan,<ref>{{cite web |title=Sudanese man sentenced to cross amputation for committing armed robbery |publisher=African Centre for Justice and Peace Studies |url=https://www.acjps.org/sudanese-man-sentenced-to-cross-amputation-for-committing-armed-robbery/}}</ref> Somalia,<ref>{{cite web |last1=Rice |first1=Xan |title=Somali schoolboy tells of how Islamists cut off his leg and hand |url=https://www.theguardian.com/world/2010/oct/20/somali-islamists-schoolboy-amputation-ordeal |website=The Guardian |date=20 October 2010}}</ref> Mauritania, the Maldives,<ref>{{cite book |url=https://academic.oup.com/book/34967/chapter-abstract/298608517?redirectedFrom=fulltext | title = Crime and Punishment in Islamic Law: A Fresh Interpretation |chapter=32: Shariah Punishments in the Islamic Republics of Mauritania and Maldives, and Islamic State of Yemen|date=2019 |doi=10.1093/oso/9780190910648.003.0032 |last1=Kamali |first1=Mohammad Hashim |pages=321–328 |isbn=978-0-19-091064-8 }}</ref> Iran,<ref>{{cite news |last1=Pannier |first1=Bruce |title=Criminals Lose Hands And Feet As Shari'a Law Imposed |url=https://www.rferl.org/a/1079325.html |website=RadioFreeEurope/RadioLiberty |language=en}}</ref> Afghanistan (under Taliban rule),{{citation needed|date=April 2025}} and Yemen.<ref>{{cite web |author=<!-- Staff--> |title=The World's Most Barbaric Punishments |url=https://www.newsweek.com/worlds-most-barbaric-punishments-74537 |website=Newsweek |language=en |date=8 July 2010}}</ref> * In 1779, [[Thomas Jefferson]] proposed a bill to the [[Virginia Assembly]] that ostensibly would have replaced [[capital punishment]] with other penalties, including amputation, for certain crimes,<ref name="Boyd TJP">{{cite book |editor-last=Boyd |editor-first=Julian P. |editor-link=Julian P. Boyd |date=1950 |title=[[The Papers of Thomas Jefferson]] |volume=2 |chapter=Bill No. 64. A Bill for Proportioning Crimes and Punishments in Cases Heretofore Capital |pages=492–507 |publisher=[[Princeton University Press]] |chapter-url=https://archive.org/details/thepapersofthoma0002unse/page/492/mode/2up |chapter-url-access=registration}}</ref><ref name="Wilson Bill 64" /> although not all were really punishable by death at the time.<ref>{{harvnb|Boyd|1950|p=505}}</ref> For the crimes of rape, sodomy, and polygamy (the last removed from a later version), the punishment was to be [[castration]] for men or [[rhinotomy]] for women.<ref>{{harvnb|Boyd|1950|pp=497,506n12}}</ref> For [[Mayhem (crime)|intentional maiming]], the bill specified literal [[eye for an eye]] retribution.<ref>{{harvnb|Boyd|1950|p=498}}</ref> The bill never passed, due to the combination of its perceived barbarity in some parts and perceived leniency in others.<ref name="Wilson Bill 64">{{cite encyclopedia |encyclopedia=Thomas Jefferson Encyclopedia |title=Bill 64 |last=Wilson |first=Gaye |date=May 1999 |url=https://www.monticello.org/research-education/thomas-jefferson-encyclopedia/bill-64/ |publisher=Thomas Jefferson Foundation}}</ref><ref>{{harvnb|Boyd|1950|pp=505–506}}</ref> * In England, the [[Offences within the Court Act 1541]] provided for cutting off a hand as punishment for striking someone inside a courtroom. Thomas Jefferson's punishments revision bill also intended to repeal this.<ref>{{harvnb|Boyd|1950|p=493}}. Jefferson cited a work of [[William Stanford (judge)|Stamford]] and the [[Offences within the Court Act 1541]] (33 Hen 8 c.<!--This stands for "chapter" not "circa". Do not use {{circa}}--> 12).</ref> The punishment was abolished in England and Wales by the [[Offences Against the Person Act 1828]]. * As of 2021, this form of punishment is controversial, as most modern cultures consider it to be morally abhorrent, as it has the effect of permanently disabling a person and constitutes torture. It is thus seen as grossly disproportionate for crimes less than those such as murder.<ref>{{Cite web |url=http://www.amnesty.org.uk/news_details.asp?NewsID=18282 |title=Somalia: Amputation punishments are 'torture' says Amnesty |publisher=Amnesty International |access-date=2021-01-08 |archive-date=2013-10-03 |archive-url=https://web.archive.org/web/20131003223301/https://www.amnesty.org.uk/news_details.asp?NewsID=18282 }}</ref>
== Surgery ==
===Method=== [[File:Curvy amputation knife DSC09451.jpg|thumb|200px|Curved knives such as this one were used, in the past, for some kinds of amputations.]] Surgeons performing an amputation have to first [[ligature (medicine)|ligate]] the supplying [[artery]] and [[vein]], so as to prevent [[hemorrhage]] (bleeding). The muscles are transected, and finally, the [[bone]] is sawed through with an [[oscillating saw]]. Sharp and rough edges of bones are filed, skin and muscle flaps are then transposed over the stump, occasionally with the insertion of elements to attach a [[prosthesis]].
[[File:Últimos_momentos_do_heroico_1º_tenente_-_Mariz_e_Barros_-_commandante_do_encouraçado_-_Tamandaré._-.jpg|thumb|left|Amputation of the leg of First Lieutenant [[Antônio Carlos de Mariz e Barros]], commander of the Brazilian [[Brazilian ironclad Tamandaré|Battleship ''Tamandaré'']] (Henrique Fleiuss, ''Semana Illustrada'', [[1866]])]]
Distal stabilisation of muscles is often performed. This allows effective muscle contraction which reduces atrophy, allows functional use of the stump and maintains soft tissue coverage of the remnant bone. The preferred stabilisation technique is myodesis where the muscle is attached to the bone or its periosteum. In joint disarticulation amputations tenodesis may be used where the muscle tendon is attached to the bone. Muscles are attached under similar tension to normal physiological conditions.<ref>{{cite book| vauthors = Smith DG |title=Atlas of Amputations and Limb Deficiencies: Surgical, Prosthetic and Rehabilitation Principles|date=2004|publisher=American Academy of Orthopaedic Surgeons|isbn=978-0-89203-313-3|pages=21–30|chapter=Chapter 2. General principles of amputation surgery.}}</ref>
An experimental technique known as the "Ewing amputation" aims to improve post-amputation [[proprioception]].<ref>{{Cite news |last=Springer |first=Shira |date=2018-04-13 |title=How The Marathon Bombing Helped Bring Innovation To Amputation |work=[[WBUR]] |url=https://www.wbur.org/news/2018/04/13/stepping-strong-brigham-amputation |access-date=2021-06-28}}</ref><ref>{{Cite web |date=2016-11-21 |title=Jim Ewing, Dynamic-Model Amputation Patient |url=https://www.brighamandwomensfaulkner.org/about-bwfh/news/ewing |access-date=2021-06-28 |website=Brigham and Women's Faulkner Hospital}}</ref> Another technique with similar goals, which has been tested in a clinical trial,<ref>[https://news.mit.edu/2021/surgery-control-prosthetic-limbs-0215 New surgery may enable better control of prosthetic limbs]</ref> is Agonist-antagonist Myoneural Interface (AMI).<ref>[https://www.media.mit.edu/projects/agonist-antagonist-myoneural-interface-ami/overview/ Agonist-antagonist Myoneural Interface (AMI)]</ref>
In 1920, Dr. Janos Ertl Sr. of [[Hungary]], developed the Ertl procedure in order to return a high number of amputees to the workforce.<ref>{{cite web|url=http://www.ertlreconstruction.com/|archive-url=https://web.archive.org/web/20040201185051/http://www.ertlreconstruction.com/|url-status=usurped|archive-date=February 1, 2004|title=Ertl Reconstruction - amputation|website=www.ertlreconstruction.com|access-date=2018-11-24}}</ref> The Ertl technique, an osteomyoplastic procedure for transtibial amputation, can be used to create a highly functional residual limb. Creation of a tibiofibular bone bridge provides a stable, broad tibiofibular articulation that may be capable of some distal weight bearing. Several different modified techniques and fibular bridge fixation methods have been used; however, no current evidence exists regarding comparison of the different techniques.<ref>{{Cite journal |vauthors=Fischgrund JS |date=June 2016 |title=JAAOS Research |journal=The Journal of the American Academy of Orthopaedic Surgeons |volume=24 |issue=6 |page=392 |doi=10.5435/jaaos-d-16-00309 |pmid=27213622 }}</ref>
=== Post-operative management === A 2019 [[Cochrane (organisation)|Cochrane]] [[systematic review]] aimed to determine whether rigid dressings were more effective than soft dressings in helping wounds heal following transtibial (below the knee) amputations. Due to the limited and very low certainty of evidence available, the authors concluded that it was uncertain what the benefits and harms were for each dressing type. They recommended that clinicians consider the pros and cons of each dressing type on a case-by-case basis: rigid dressings may potentially benefit patients who have a high risk of falls; soft dressings may potentially benefit patients who have poor skin integrity.<ref>{{cite journal | vauthors = Kwah LK, Webb MT, Goh L, Harvey LA | title = Rigid dressings versus soft dressings for transtibial amputations | journal = The Cochrane Database of Systematic Reviews | volume = 2019 | article-number = CD012427 | date = June 2019 | issue = 6 | pmid = 31204792 | pmc = 6573094 | doi = 10.1002/14651858.cd012427.pub2 }}</ref>
A 2017 review found that the use of rigid removable dressings (RRD's) in trans-tibial amputations, rather than soft bandaging, improved healing time, reduced edema, prevented knee flexion contractures and reduced complications, including further amputation, from external trauma such as falls onto the stump.<ref>{{cite journal | vauthors = Reichmann JP, Stevens PM, Rheinstein J, Kreulen CD | title = Removable Rigid Dressings for Postoperative Management of Transtibial Amputations: A Review of Published Evidence | journal = PM&R | volume = 10 | issue = 5 | pages = 516–523 | date = May 2018 | pmid = 29054690 | doi = 10.1016/j.pmrj.2017.10.002 | s2cid = 21732925 }}</ref>
Post-operative management, in addition to wound healing, considers maintenance of limb strength, joint range, edema management, preservation of the intact limb (if applicable) and stump desensitization.
== Trauma == Traumatic amputation is the partial or total avulsion of a part of a body during a serious accident, like traffic, labor, or combat.<ref>{{Cite book |url=https://accessmedicine.mhmedical.com/book.aspx?bookid=675 |title=Current Diagnosis & Treatment in Orthopedics |vauthors=Smith DG, Skinner HB |date=2014 |publisher=McGraw-Hill Education. |isbn=978-0-07-159075-4 |veditors=Skinner HB, McMahon PJ |edition=5th |chapter=Amputations |chapter-url=https://accessmedicine.mhmedical.com/content.aspx?bookid=675§ionid=45451717}}</ref><ref name="Watson1986">{{Cite book |title=Hand Injuries and Infections |vauthors=Watson N |publisher=Gower Medical |year=1986 |isbn=0-906923-80-8 |location=London}}</ref>
Traumatic amputation of a human limb, either partial or total, creates the immediate danger of death from blood loss.<ref>{{Cite journal |vauthors=Ramirez C, Menaker J |date=2017-05-01 |title=Traumatic Amputations |url=https://www.reliasmedia.com/articles/140552-traumatic-amputations |journal=Trauma Reports |volume=18 |issue=3}}</ref>
Orthopedic surgeons often assess the severity of different injuries using the Mangled Extremity Severity Score. Given different clinical and situational factors, they can predict the likelihood of amputation. This is especially useful for emergency physicians to quickly evaluate patients and decide on consultations.<ref>{{cite journal | vauthors = Johansen K, Daines M, Howey T, Helfet D, Hansen ST | title = Objective criteria accurately predict amputation following lower extremity trauma | journal = The Journal of Trauma | volume = 30 | issue = 5 | pages = 568–72; discussion 572–3 | date = May 1990 | pmid = 2342140 | doi = 10.1097/00005373-199005000-00007 | doi-access = free }}</ref>
===Causes=== [[File:3372709503 10dc75d783 oSéquelleAmputation.jpg|thumb|170px|Private Lewis Francis was wounded July 21, 1861, at the [[First Battle of Bull Run]] by a bayonet to the knee.]] Traumatic amputation is uncommon in humans (1 per 20,804 population per year). Loss of limb usually happens immediately during the accident, but sometimes a few days later after medical complications. Statistically, the most common causes of traumatic amputations are:<ref>{{Cite web |date=2017-10-17 |title=Amputation |url=https://www.nhs.uk/conditions/amputation/ |access-date=2022-09-07 |website=nhs.uk |language=en}}</ref> * Vehicle accidents (cars, motorcycles, bicycles, trains, etc.) * Labor accidents (equipment, instruments, cylinders, chainsaws, press machines, meat machines, wood machines, etc.) * Agricultural accidents, with machines and mower equipment * Electric shock hazards * Firearms, bladed weapons, explosives * Violent rupture of ship rope or industry wire rope * Ring traction (ring amputation, de-gloving injuries) * Building doors and car doors * Animal attacks * Gas cylinder explosions<ref>{{Cite magazine |date=February 2011 |editor-last=Davison |editor-first=Ben |title=Scuba Tanks as Lethal Weapons |url=https://www.undercurrent.org/UCnow/dive_magazine/2011/LethalWeapons201102.html |url-status=live |magazine=Undercurrent |publication-place=Sausalito, California |volume=26 |issue=2 |pages=8–9 |archive-url=https://web.archive.org/web/20210428060005/https://www.undercurrent.org/UCnow/dive_magazine/2011/LethalWeapons201102.html |archive-date=2021-04-28 |access-date=28 June 2021}}</ref> * Other rare accidents<ref>{{Cite journal |last1=Clasper |first1=Jon |last2=Ramasamy |first2=Arul |date=2013 |title=Traumatic amputations |journal=British Journal of Pain |volume=7 |issue=2 |pages=67–73 |doi=10.1177/2049463713487324 |issn=2049-4637 |pmc=4590129 |pmid=26516502}}</ref>
===Treatment=== The development of the science of [[microsurgery]] over the last 40 years has provided several treatment options for a traumatic amputation, depending on the patient's specific trauma and clinical situation:<ref>{{Cite journal |last1=Yoo |first1=Hyokyung |last2=Kim |first2=Byung Jun |date=2021-07-27 |title=History and Recent Advances in Microsurgery |url=https://synapse.koreamed.org/articles/1147742 |journal=Archives of Hand and Microsurgery |volume=26 |issue=3 |pages=174–183 |doi=10.12790/ahm.21.0097|doi-access=free }}</ref> * 1st choice: Surgical amputation - break - prosthesis * 2nd choice: Surgical amputation - transplantation of other tissue - plastic reconstruction. * 3rd choice: [[Replantation]] - reconnection - revascularisation of amputated limb, by microscope (after 1969) * 4th choice: Transplantation of cadaveric hand (after 2000)<ref name="Watson1986" />
===Epidemiology=== [[File:In Khmelnytskyi, the President Paid a Visit to the Warriors Recovering from Wounds and Presented Them with Awards. (53698029200).jpg|thumb|Up to 50,000 Ukrainians lost their limbs during the [[Russo-Ukrainian war (2022–present)|Russo-Ukrainian war]].<ref>{{cite news |title='A new life': Ukrainian war amputees travel to Germany for custom-made limbs |url=https://edition.cnn.com/2024/06/03/europe/ukraine-soldiers-germany-prosthetic-limbs-intl-cmd/index.html |work=CNN |date=3 June 2024}}</ref>]] * In the United States in 1999, there were 14,420 non-fatal traumatic amputations according to the [[American Statistical Association]]. Of these, 4,435 occurred as a result of traffic and transportation accidents and 9,985 were due to labor accidents. Of all traumatic amputations, the distribution percentage is 30.75% for traffic accidents and 69.24% for labor accidents.<ref name="amstat.org">{{Cite web|url=https://www.amstat.org//|title=American Statistical Association (ASA)|website=www.amstat.org}}</ref>{{Nonspecific|date=June 2021}} * The United States Bureau of Labor Statistics reported 6,200 cases of work-related amputations in 2018. The most common causes of amputations were machinery (58% cases), crush injuries from parts or material (15%), and other tools/instruments/equipment such hand tools (7%).<ref>{{Cite web |title=Machinery involved in 58 percent of work-related amputations in 2018 |url=https://www.bls.gov/opub/ted/2020/machinery-involved-in-58-percent-of-work-related-amputations-in-2018.htm |access-date=2025-06-12 |website=Bureau of Labor Statistics |language=en-us}}</ref> * A study found that in 2010, 22.8% of patients undergoing amputation of a lower extremity in the United States were readmitted to the hospital within 30 days.<ref>{{Cite journal |vauthors=Weiss AJ, Elixhauser A, Steiner C |date=April 2013 |title=Readmissions to U.S. Hospitals by Procedure, 2010 |url=https://hcup-us.ahrq.gov/reports/statbriefs/sb154.jsp |journal=HCUP Statistical Brief |issue=154 |publisher=[[U.S. Agency for Healthcare Research and Quality]] |pmid=24006552 |publication-place=Rockville, Maryland}}</ref> * In 2017, an estimated 57.7 million people globally were living with existing traumatic limb injuries. Of these 57.7 million, the leading causes of amputation "were falls (36.2%), road injuries (15.7%), other transportation injuries (11.2%), and mechanical forces (10.4%)."<ref>{{Cite journal |last1=McDonald |first1=Cody L. |last2=Westcott-McCoy |first2=Sarah |last3=Weaver |first3=Marcia R. |last4=Haagsma |first4=Juanita |last5=Kartin |first5=Deborah |date=2021-04-01 |title=Global prevalence of traumatic non-fatal limb amputation |journal=Prosthetics and Orthotics International |volume=45 |issue=2 |pages=105–114 |doi=10.1177/0309364620972258 |issn=1746-1553 |pmid=33274665}}</ref> * On 2 August 2023, an investigation by ''[[The Wall Street Journal]]'' found that Ukrainian medical amputations in the war came to between 20,000 and 50,000 including both military and civilians. In comparison, during [[World War One]] 41,000 British and 67,000 Germans needed amputations.<ref>{{cite web |url=https://www.businessinsider.com/amputations-ukraine-levels-not-seen-since-world-war-i-report-2023-8 |title=Amputations in Ukraine are as widespread as in the trenches of World War I due to Russia's heavy use of mines and artillery: report |date=2 August 2023 |last=Porter |first=Tom |work=[[Business Insider]]}}</ref> * In 2025, Israel's [[Israeli war crimes in the Gaza war|attacks]] on the [[Gaza Strip]] during the [[Gaza war]] caused Gaza to have the highest number of [[Effect of the Gaza war on children in the Gaza Strip|child amputees]] per capita in the world.<ref>[https://www.aljazeera.com/program/the-stream/2024/7/2/the-amputee-crisis-in-the-war-on-gaza The amputee crisis in the war on Gaza], 2 July 2024</ref><ref>{{cite news |last1=Moor |first1=Ahmed |title=There are more child amputees in Gaza than anywhere else in the world. What can the future hold for them? |url=https://www.theguardian.com/world/ng-interactive/2025/mar/27/gaza-palestine-children-injuries |work=The Guardian |date=27 March 2025}}</ref>
==Prevention== Methods in preventing amputation, [[limb-sparing techniques]], depend on the problems that might cause amputations to be necessary. Chronic infections, often caused by diabetes or [[decubitus ulcers]] in bedridden patients, are common causes of infections that lead to gangrene, which, when widespread, necessitates amputation.<ref>{{Cite web |date=2019-11-19 |title=Gangrene |url=https://www.hopkinsmedicine.org/health/conditions-and-diseases/gangrene |access-date=2023-10-31 |website=www.hopkinsmedicine.org |language=en}}</ref>
There are two key challenges: first, many patients have impaired circulation in their extremities, and second, they have difficulty curing infections in limbs with poor blood circulation.<ref>{{Cite web |last=CDC |date=2023-04-07 |title=Preventing Diabetes-Related Amputations (Part 1) |url=https://www.cdc.gov/diabetes/library/features/amputations.html |access-date=2023-10-31 |website=Centers for Disease Control and Prevention |language=en-us}}</ref><ref>{{Cite web |title=Avoiding Amputations |url=https://www.templehealth.org/services/heart-vascular/patient-care/patient-support/understanding-heart-vascular-disease/avoiding-amputations |access-date=2023-10-31 |website=Temple Health |language=en}}</ref>
Crush injuries where there is extensive tissue damage and poor circulation also benefit from [[Hyperbaric medicine|hyperbaric oxygen therapy]] (HBOT). The high level of oxygenation and revascularization speed up recovery times and prevent infections.<ref>{{Cite web |title=Hyperbaric oxygen therapy - Mayo Clinic |url=https://www.mayoclinic.org/tests-procedures/hyperbaric-oxygen-therapy/about/pac-20394380 |access-date=2023-10-31 |website=www.mayoclinic.org |language=en}}</ref>
A study found that the patented method called Circulator Boot achieved significant results in prevention of amputation in patients with diabetes and arteriosclerosis.<ref name=dillon1>{{cite journal | vauthors = Bouskela E, Donyo KA | title = Effects of oral administration of purified micronized flavonoid fraction on increased microvascular permeability induced by various agents and on ischemia/reperfusion in the hamster cheek pouch | journal = Angiology | volume = 48 | issue = 5 | pages = 391–9 | date = May 1997 | pmid = 9158383 | doi = 10.1177/000331979704800503 | s2cid = 28978927 | url = http://www.circulatorboot.com/literature/angiology1.html | archive-url = https://web.archive.org/web/20101125035502/http://circulatorboot.com/literature/angiology1.html | archive-date = 2010-11-25 | access-date = 2010-06-24 | url-access = subscription }}</ref><ref name=dillon2>{{cite journal | vauthors = Dillon RS | title = Patient assessment and examples of a method of treatment. Use of the circulator boot in peripheral vascular disease | journal = Angiology | volume = 48 | issue = 5 Pt 2 | pages = S35–58 | date = May 1997 | pmid = 9158380 | doi = 10.1177/000331979704800504 | s2cid = 23512929 | url = http://www.circulatorboot.com/literature/angiology1.html | archive-url = https://web.archive.org/web/20101125035502/http://circulatorboot.com/literature/angiology1.html | archive-date = 2010-11-25 | access-date = 2010-06-24 | url-access = subscription }}</ref> Another study found it also effective for healing limb ulcers caused by peripheral vascular disease.<ref name=vella>{{cite journal | vauthors = Vella A, Carlson LA, Blier B, Felty C, Kuiper JD, Rooke TW | title = Circulator boot therapy alters the natural history of ischemic limb ulceration | journal = Vascular Medicine | volume = 5 | issue = 1 | pages = 21–5 | year = 2000 | pmid = 10737152 | doi = 10.1177/1358836X0000500104 }}</ref> The boot checks the heart rhythm and compresses the limb between heartbeats; the compression helps cure the wounds in the walls of veins and arteries, and helps to push the blood back to the heart.<ref>{{Cite AV media |url=https://newsnetwork.mayoclinic.org/discussion/circulator-boot/ |title=Circulator Boot |date=2008-07-11 |last=Williams |first=Vivien |type=video |publisher=[[Mayo Clinic|Mayo Clinic News Network]] |time=1:08–1:32 |access-date=2021-06-27}}</ref>
For victims of trauma, advances in [[microsurgery]] in the 1970s have made replantation of severed body parts possible.
The establishment of laws, rules, and guidelines, and the employment of modern equipment help protect people from traumatic amputations.<ref>{{Cite journal |last1=Roon |first1=Anthony J. |last2=Moore |first2=Wesley S. |last3=Goldstone |first3=Jerry |date=1977 |title=Below-knee amputation: A modern approach |journal=The American Journal of Surgery |volume=134 |issue=1 |pages=153–158 |doi=10.1016/0002-9610(77)90299-9 |pmid=879408 |issn=0002-9610}}</ref>
==Prognosis== The individual may experience psychological trauma and emotional discomfort. The stump will remain an area of reduced mechanical stability. Limb loss can present significant or even drastic practical limitations.<ref name="Amputation">{{Cite web |date=2023-03-15 |title=Amputation |url=https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/amputation |access-date=2023-10-31 |website=www.hopkinsmedicine.org |language=en}}</ref>
A large proportion of amputees (from 50 to 80% to 80–100%, according to different studies) experience the phenomenon of [[phantom limb]]s;<ref>{{cite journal|date=January 2005 |title=The Science of Things | first = Heidi | last = Schultz | name-list-style = vanc |journal=National Geographic Magazine |url=http://magma.nationalgeographic.com/ngm/0501/resources_who.html |archive-url=https://web.archive.org/web/20080906143209/http://magma.nationalgeographic.com/ngm/0501/resources_who.html |archive-date=September 6, 2008 }}</ref><ref name="PhantomReview2007">{{cite journal |last1=Chahine |first1=Lama |last2=Kanazi |first2=Ghassan |date=2007 |title= Phantom limb syndrome: A review |url=https://pdfs.semanticscholar.org/0f8d/2b80b5c20ed0e21076de4b5ac48327ca05d2.pdf |archive-url=https://web.archive.org/web/20190721010514/https://pdfs.semanticscholar.org/0f8d/2b80b5c20ed0e21076de4b5ac48327ca05d2.pdf |archive-date=2019-07-21 |journal= MEJ Anesth|volume=19 |issue= 2|pages=345–55 |s2cid=16240786 |access-date=July 20, 2019 }}</ref> they feel body parts that are no longer there. These limbs can itch, ache, burn, feel tense, dry or wet, locked in or trapped or they can feel as if they are moving. Some scientists believe it has to do with a kind of neural map that the brain has of the body, which sends information to the rest of the brain about limbs regardless of their existence. Phantom sensations and [[phantom pain]] may also occur after the removal of body parts other than the limbs, e.g. after amputation of the breast, extraction of a tooth (phantom tooth pain) or removal of an eye ([[phantom eye syndrome]]).
A similar phenomenon is an unexplained sensation in a body part unrelated to the amputated limb. It has been hypothesized that the portion of the brain responsible for processing stimulation from amputated limbs, being deprived of input, expands into the surrounding brain, (''[[Phantoms in the Brain]]'': [[V.S. Ramachandran]] and [[Sandra Blakeslee]]) such that an individual who has had an arm amputated will experience unexplained pressure or movement on his face or head.<ref>{{Cite journal |last1=MacIver |first1=K. |last2=Lloyd |first2=D. M. |last3=Kelly |first3=S. |last4=Roberts |first4=N. |last5=Nurmikko |first5=T. |date=August 2008 |title=Phantom limb pain, cortical reorganization and the therapeutic effect of mental imagery |journal=Brain |volume=131 |issue=8 |pages=2181–2191 |doi=10.1093/brain/awn124 |issn=0006-8950 |pmid=18567624|pmc=2494616 }}</ref>
In many cases, the phantom limb aids in adaptation to a prosthesis, as it permits the person to experience [[proprioception]] of the prosthetic limb. To support improved resistance or usability, comfort or healing, some types of [[stump sock]]s may be worn instead of or as part of wearing a prosthesis.<ref name="Amputation"/>
Another side effect can be [[heterotopic ossification]], especially when a bone injury is combined with a head injury. The brain signals the bone to grow instead of scar tissue to form, and nodules and other growth can interfere with prosthetics and sometimes require further operations. This type of injury has been especially common among soldiers wounded by [[improvised explosive device]]s in the [[Iraq War]].<ref>{{cite news |url=http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2006/03/26/MNSOLDIERS26.DTL |title=War without end / Damaged soldiers start their agonizing recoveries |first=Joan |last=Ryan |name-list-style=vanc |date=March 25, 2006 |work=The San Francisco Chronicle |archive-url=https://web.archive.org/web/20110208093622/http://www.sfgate.com/cgi-bin/article.cgi?f=%2Fc%2Fa%2F2006%2F03%2F26%2FMNSOLDIERS26.DTL |archive-date=February 8, 2011 |url-status=dead |access-date=June 4, 2017 }}</ref>
Due to technological advances in prosthetics, many amputees live active lives with little restriction. Organizations such as the [[Challenged Athletes Foundation]] have been developed to give amputees the opportunity to be involved in athletics and [[adaptive sports]] such as [[Amputee football|amputee soccer]].<ref>{{Cite web |last=Hoock |first=Maja |date=September 2021 |title=Innovative prostheses positively change the Paralympics |url=https://www.wipo.int/wipo_magazine/en/2021/03/article_0007.html |access-date=October 30, 2023 |website=WIPO}}</ref>
Nearly half of the individuals who have an amputation due to vascular disease will die within 5 years, usually secondary to the extensive co-morbidities rather than due to direct consequences of an amputation. This is higher than the five year mortality rates for breast cancer, colon cancer, and prostate cancer.<ref>{{cite journal | vauthors = Robbins JM, Strauss G, Aron D, Long J, Kuba J, Kaplan Y | s2cid = 38232703 | title = Mortality rates and diabetic foot ulcers: is it time to communicate mortality risk to patients with diabetic foot ulceration? | journal = Journal of the American Podiatric Medical Association | volume = 98 | issue = 6 | pages = 489–93 | date = November 2008 | pmid = 19017860 | doi = 10.7547/0980489 }}</ref> Of persons with diabetes who have a lower extremity amputation, up to 55% will require amputation of the second leg within two to three years.<ref>{{cite book| vauthors = Savage PE |chapter=The diabetic foot|date=1983|pages=69–73|publisher=Springer Netherlands|isbn=978-94-011-6650-8|doi=10.1007/978-94-011-6648-5_12|title=Problems in Peripheral Vascular Disease}}</ref>
== Medieval and Early Modern Europe == Amputations in medieval and early modern Europe were mainly the result of warfare, disease, work accidents, and punishment. Amputations were performed by [[Barber surgeon|barber-surgeons]].<ref name=":3" />
=== Disease === One of the major causes of amputation in medieval Europe was disease. [[Ergotism]] (also known as Saint-Anthony's fire) was a fungus found in rye that caused gangrene that spread from the fingers and toes. If the tissue death from the disease was severe enough, the limb would spontaneously fall off on its own without blood loss.<ref>{{Cite book |last=Kirkup|first=John|title=A History of Limb Amputation|date=2007|publisher=Springer|isbn=9781846284434|location=London|pages=16}}</ref>
=== Warfare === Warfare amputations became more necessary in Europe after European armies started using guns in the fourteenth century. At the time, bullet wounds were often too complicated for surgeons to handle, and amputation was their best solution.<ref>{{Cite journal |last1=Stansbury|first1=Lynn G.|last2=Branstetter|first2=Joanna G.|last3=Lalliss|first3=Steven J.|date=2007|title=Amputation in Military Trauma Surgery|url=https://journals.lww.com/00005373-200710000-00042|journal=Journal of Trauma: Injury, Infection & Critical Care|language=en|volume=63|issue=4|pages=940–944|doi=10.1097/TA.0b013e31814934d8|pmid=18090027 |issn=0022-5282|url-access=subscription}}</ref> In the late fifteenth century, we see more documentation of amputations as [[Hieronymus Brunschwig]] and [[Hans von Gersdorff|Hans Von Gersdorff]] both illustrated amputation scenes, with the latter also writing about gunshot injuries.<ref>{{Cite book |last=Kirkup|first=John|title=A History of Limb Amputation|date=2007|publisher=Springer-Verlag London Ltd|isbn=978-1-84628-443-4|series=SpringerLink Bücher|location=London}}</ref> Gersdorff's writings showed that surgeons at the time struggled with whether the gunpowder on the wound further worsened the injuries. Therefore, it was a common practice to cauterize the wounds with hot oil until [[Ambroise Paré]] discovered that this impeded healing, and concluded that gunshot wounds should not be cauterized. This led to another significant contribution of his to warfare medicine: the revival of [[Ligature (medicine)|ligature]], which replaced cauterization of amputation wounds. Paré updated ligature to make safer, and it became common practice.<ref>{{Cite journal |last1=Markatos|first1=Konstantinos|last2=Tzivra|first2=Anna|last3=Tsoutsos|first3=Spyridon|last4=Tsourouflis|first4=Gerasimos|last5=Karamanou|first5=Marianna|last6=Androutsos|first6=Georgios|date=2018-04-01|title=Ambroise Paré (1510-1590) and His Innovative Work on the Treatment of War Injuries|url=https://doi.org/10.1177/1553350617744901|journal=Surgical Innovation|language=EN|volume=25|issue=2|pages=183–186|doi=10.1177/1553350617744901|pmid=29202658 |issn=1553-3506|url-access=subscription}}</ref>
=== Amputation as punishment === There is evidence of amputation as punishment dating back to 1750 BCE. The Babylonian Code of [[Hammurabi|King Hammurabi]] sanctioned amputation as a punishment. Amputation as a punishment continued in ancient [[Peru]], where the part of the body amputated had a connection to the crime committed (for example, stealing might be punished by amputating the hand of the guilty). Amputation continued as a form of punishment into the Roman period as well as the Byzantine period, but became less prominent after the collapse of the [[Byzantine Empire]]. These punishments increased again during the [[Middle Ages]], but declined again after perceptions of punitive amputation changed significantly during the [[Renaissance]] and [[Age of Enlightenment|Enlightenment]].<ref>{{Cite journal |last1=Mavroforou|first1=Anna|last2=Malizos|first2=Konstantinos|last3=Karachalios|first3=Theofilos|last4=Chatzitheofilou|first4=Konstantinos|last5=Giannoukas|first5=Athanasios D.|date=2014|title=Punitive Limb Amputation|journal=Clinical Orthopaedics & Related Research|language=en|volume=472|issue=10|pages=3102–3106|doi=10.1007/s11999-014-3480-6|issn=0009-921X|pmc=4160514|pmid=24522383}}</ref>
In [[England in the Middle Ages|medieval England]], corpses would sometimes be amputated after death as a form of public shaming or punishment.<ref>Fernandes, Teresa, Marco Liberato, Carina Marques, and Eugénia Cunha. “Three Cases of Feet and Hand Amputation from Medieval Estremoz, Portugal.” ''International Journal of Paleopathology'' 18 (2017): 63-68. <nowiki>https://doi.org/10.1016/j.ijpp.2017.05.007</nowiki>.</ref> This would’ve been especially meaningful at the time, as the state of the physical body after death was significant to [[Christianity in the Middle Ages|medieval Christians]]. Additionally, archaeologists found evidence of postmortem decapitation from medieval times, which some speculated to be related to rituals or where the soul goes after death.
There is also documentation of nose amputation being used as a form of punishment or retaliation. In [[France]] during the 5th and 6th centuries, nose cutting was prominent enough to be classified as its own crime, which would result in a serious fine to the perpetrator. However, it was also occasionally used as a punishment for serious crimes such as threatening royals.<ref>{{Cite journal |title=Project MUSE -- Verification required!|url=https://muse.jhu.edu/verify?url=%2Farticle%2F540498&r=8075186|access-date=2026-04-27|website=muse.jhu.edu|doi=10.1353/jowh.2014.0016|url-access=subscription}}</ref> The field of [[plastic surgery]] was brought to Europe, specifically [[Catania]], in the fifteenth century, when Gustavo Branca successfully completed an ancient Indian method of reconstructive [[rhinoplasty]]. Plastic surgery continued to grow as a field across the continent, and the birth of this field is likely related to nose amputation as punishment.<ref>{{Cite journal |last=Micali|first=G.|date=December 1993|title=The Italian Contribution to Plastic Surgery|url=http://journals.lww.com/00000637-199312000-00019|journal=Annals of Plastic Surgery|language=en|volume=31|issue=6|pages=566–571|doi=10.1097/00000637-199312000-00019|pmid=8297094 |issn=0148-7043|url-access=subscription}}</ref>
=== Theories on amputation === In medieval Europe, amputation was done on limbs as a last resort when the limb could not be saved. For limbs that were dead or decaying, surgeons categorized them into two main categories: hot fire and cold fire. Hot fire (also called Gangraena) was the first stage of a decaying limb. A body part with hot fire was hot, swollen, and painful. If not treated, the limb would turn cold. Cold fire (also called Sphacelus) was the late stage of limb death, including death of the bone. Symptoms included loss of feeling, coldness, and black and blue coloring. With time, the fire would spread and eventually kill the patient.<ref name=":0">Hausse, Heidi. “Communities Face the Cold Fire.” Chapter. In ''The Malleable Body: Surgeons, Artisans, and Amputees in Early Modern Germany'', 51–81. Manchester University Press, n.d.</ref>
Followers of [[Galen]] considered hot and cold fire to be based on the humors and an imbalance of hot, wet, dry, and cold in the body. Followers of [[Paracelsus]] believed that hot and cold fire were a result of Mercury, sulfur, and salt. While different surgeons drew from different medical theories of the time, they also used their own experiences to determine the root cause of the fires. There was often debate on whether a particular patient had cold or hot fire, which led to disagreements on treatment methods.<ref name=":0" />
Treatment for hot fire often included burning or cutting out damaged flesh. If the symptoms were mild enough, the skin could sometimes be regrown. Treatment for cold fire included removing the dead flesh and likely amputation.<ref name=":0" />
=== Amputation methods === Throughout Europe, there were varying approaches when it came to amputations. The two main considerations for amputation procedures were how fast it could be performed and how it would heal. The mallet-and-wedge technique involved setting the body part on a wedge and hitting the wedge with a mallet. This separated the limb or digit from the body by crushing it. This method was very fast but left a messy result that caused the crushed bones to splinter into the remaining part of the limb. The hand's-width method used a curved knife to cut through the limb's tissue, and a bow-frame saw to cut through the bone. An assistant would pull the flesh upwards to expose the bone. After the limb was sawed off, the flesh would then be pulled back over the stump to create a cushion. This procedure took longer but healed more easily.<ref name=":1">Hausse, Heidi. “Visions of the Body.” Chapter. In ''The Malleable Body: Surgeons, Artisans, and Amputees in Early Modern Germany'', 82–118. Manchester University Press, n.d.</ref>
One method to stop hemorrhaging after amputation was iron [[Cauterization|cautery]]. This involved taking hot iron instruments to the new stump and burning off the exposed tissue, closing the blood vessels. Another method of cauterization was to apply corrosive chemicals to the fresh wound to burn the blood vessels and stop the bleeding. Both methods were efficient but led to a long healing process. A different method was [[Ligature (medicine)|ligation]]. This technique required the surgeon to draw out the individual blood vessels and tie them shut. This process was much more time-consuming but healed more quickly.<ref name=":1" />
There was also debate among barber-surgeons on the location of amputation. One rationale was to amputate as close to the damage as possible to save as much of the remaining limb as possible. Others argued to amputate in a location that would fit a prosthetic the best. This was especially debated for lower leg amputation because a prosthetic would fit better if the leg was amputated closer to the knee.<ref name=":1" /> Paré is the first known surgeon to decide the location of an amputation based on how a prosthetic would fit on it in 1564.<ref name=":3">{{Cite web |last=Ficarra|first=Bernard J.|date=1943|title=Amputations and Prostheses Through the Centuries|url=https://wellcomecollection.org/works/g7nuf9qf/items|website=Welcome Collection}}</ref>
=== Prosthetics === Prosthetics in the early modern period were made from wood, metal, and leather. The majority of prosthetic artifacts from the period still around today were made of metal. In Germany, metal mechanical hands were made with ratchets and springs. The springs allowed for movement of the fingers, while the ratchets locked them in place. The wearer was able to control the fingers by releasing the ratchets through buttons or levers, depending on the hand. The specific mechanics of the hand varied by prosthetic.<ref name=":2">Hausse, Heidi. “Mechanical Hands.” Chapter. In ''The Malleable Body: Surgeons, Artisans, and Amputees in Early Modern Germany'', 155–209. Manchester University Press, n.d.</ref>
Mechanical prosthetics were the work of artisans, specifically locksmiths and clockmakers. This was because locksmiths and clockmakers were already using springs and ratchets to make locks, doors, and clocks.<ref name=":2" />
==Etymology== The word amputation is borrowed from Latin ''amputātus,'' past participle of ''amputāre'' "to prune back (a plant), prune away, remove by cutting (unwanted parts or features), cut off (a branch, limb, body part)," from ''am-,'' assimilated variant of ''amb-'' "about, around" + ''putāre'' "to prune, make clean or tidy, scour (wool)". The English word "Poes" was first applied to surgery in the 17th century, possibly first in Peter Lowe's ''A discourse of the Whole Art of Chirurgerie'' (published in either 1597 or 1612); his work was derived from 16th-century French texts and early English writers also used the words "extirpation" (16th-century French texts tended to use ''extirper''), "[[disarticulation]]", and "[[dismemberment]]" (from the Old French ''desmembrer'' and a more common term before the 17th century for limb loss or removal), or simply "cutting", but by the end of the 17th century "amputation" had come to dominate as the accepted medical term.<ref>{{Cite book |last=Lowe |first=Peter |url=http://archive.org/details/b30327994_0003 |title=A discourse of the whole art of chyrurgerie. Wherein is exactly set downe the definition, causes, accidents, prognostications, and cures of all sorts of diseases ... Wherunto is added the rule of making remedies which chirurgions doe commonly use: with the Presages of divine Hyppocrates |date=1612 |publisher=London : Thomas Purfoot |others=Wellcome Library}}</ref>
==Notable cases== ===Without prosthesis=== * [[Rick Allen (drummer)|Rick Allen]] * [[Bethany Hamilton]]
===With prosthesis=== * [[Götz von Berlichingen|Götz of the Iron Hand]] * [[Jessica Long]] * [[Sarah Reinertsen]]
===Other=== {{Div col|colwidth=15em}} * [[Patch Adams]] * [[Douglas Bader]] * [[Carl Brashear]] * [[Lisa Bufano]] * [[Roberto Carlos (singer)|Roberto Carlos]] * [[Tammy Duckworth]] * [[Kalamandalam Sankaran Embranthiri]] * [[Terry Fox]] * [[Zach Gowen]] * [[Pete Gray]] * [[Shaquem Griffin]] * [[Robert David Hall]] * [[Hugh Herr]] * [[Frida Kahlo]] * [[Ronnie Lott]] * [[Hari Budha Magar]] * [[Aimee Mullins]] * [[Oscar Pistorius]] * [[Amy Purdy]] * [[Aron Ralston]] * [[Hans-Ulrich Rudel]] * [[Luiz Inácio Lula da Silva]] * [[Henri de Tonti]] * [[Alex Zanardi]] * [[Lev Yashin]] {{Div col end}}
== See also == {{columns-list|colwidth=25em| * [[Acrotomophilia]] * [[Adapted automobile]] * [[Flail limb]] * [[Robotic prosthesis control]]
}}
== References == {{reflist|colwidth=30em}}
== Further reading == * Bilguer, Johann Ulrich, (1764), ''[https://www.gutenberg.org/ebooks/44089 A dissertation on the inutility of the amputation of limbs]''. * Miller, Brian Craig. ''Empty Sleeves: Amputation in the Civil War South'' (University of Georgia Press, 2015). xviii, 257 pp.
{{Medical resources | DiseasesDB = | ICD11 = ''Medical'': {{ICD11|PK80.80}}; ''Traumatic'': {{ICD11|NA09}}, {{ICD11|NA63}}, {{ICD11|NB33}}, {{ICD11|NC18}}, {{ICD11|NC38}}, {{ICD11|NC59}}, {{ICD11|NC78}}, {{ICD11|NC98}}, {{ICD11|ND19}}, {{ICD11|ND35}} | ICD10 = ''Medical'': {{ICD10|Y83.5}}; ''Traumatic'': S*8 (e.g. {{ICD10|S68}}), {{ICD10|T05}}, {{ICD10|T09.6}}, {{ICD10|T11.6}}, {{ICD10|T13.6}}, {{ICD10|T14.7}} | ICD9 = | ICDO = | OMIM = | MedlinePlus = | eMedicineSubj = | eMedicineTopic = | MeshID = D000673 }}
{{Muscle/soft tissue procedures}} {{Substantive human rights}}
{{Authority control}}
[[Category:Amputation| ]] [[Category:Surgical removal procedures]] [[Category:Acute pain]] [[Category:Punishments]] [[Category:Surgery]]