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is 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 58 epidemiology edit up to 50 000 ukrainians lost their limbs during the russo ukrainian war 65 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 66 not specific enough to verify 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 67 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 68 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 69 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 70 in 2025 israel s attacks on the gaza strip during the gaza war caused gaza to have the highest number of child amputees per capita in the world 71 72 prevention edit 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 73 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 74 75 crush injuries where there is extensive tissue damage and poor circulation also benefit from hyperbaric oxygen therapy hbot the high level of oxygenation and revascularization speed up recovery times and prevent infections 76 a study found that the patented method called circulator boot achieved significant results in prevention of amputation in patients with diabetes and arteriosclerosis 77 78 another study found it also effective for healing limb ulcers caused by peripheral vascular disease 79 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 80 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 81 prognosis edit 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 82 a large proportion of amputees from 50 to 80 to 80 100 according to different studies experience the phenomenon of phantom limbs 83 84 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 85 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 socks may be worn instead of or as part of wearing a prosthesis 82 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 devices in the iraq war 86 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 soccer 87 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 88 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 89 medieval and early modern europe edit amputations in medieval and early modern europe were mainly the result of warfare disease work accidents and punishment amputations were performed by barber surgeons 90 disease edit 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 91 warfare edit 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 92 in the late fifteenth century we see more documentation of amputations as hieronymus brunschwig and hans von gersdorff both illustrated amputation scenes with the latter also writing about gunshot injuries 93 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 which replaced cauterization of amputation wounds paré updated ligature to make safer and it became common practice 94 amputation as punishment edit there is evidence of amputation as punishment dating back to 1750 bce the babylonian code of 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 enlightenment 95 in medieval england corpses would sometimes be amputated after death as a form of public shaming or punishment 96 this would ve been especially meaningful at the time as the state of the physical body after death was significant to 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 97 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 98 theories on amputation edit 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 99 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 99 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 99 amputation methods edit 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 100 one method to stop hemorrhaging after amputation was iron 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 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 100 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 100 paré is the first known surgeon to decide the location of an amputation based on how a prosthetic would fit on it in 1564 90 prosthetics edit 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 101 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 101 etymology edit 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 102 notable cases edit without prosthesis edit rick allen bethany hamilton with prosthesis edit götz of the iron hand jessica long sarah reinertsen other edit patch adams douglas bader carl brashear lisa bufano 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 see also ed...
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