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or other tissues 18 its pathophysiology involves the formation of ice crystals upon freezing and blood clots upon thawing leading to cell damage and cell death 18 treatment of severe frostbite may require surgical amputation of the affected tissue or limb 19 if there is deep injury autoamputation may occur 20 athletic performance edit sometimes professional 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 21 rugby union player jone tawake also had a finger removed 22 national football league safety ronnie lott had the tip of his little finger removed after it was damaged in the 1985 nfl season 23 criminal penalties edit 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 24 iran 25 26 saudi arabia 27 yemen 28 and 11 of the 36 states within nigeria 29 30 cross amputation is one of the hudud punishments prescribed under islamic jurisprudence sharia law and involves cutting off the right hand and left foot of the alleged transgressor 31 32 the scriptural authority for the double amputation procedure is in the quran surah 5 33 34 which stipulates 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 33 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 34 sudan 35 somalia 36 mauritania the maldives 37 iran 38 afghanistan under taliban rule citation needed and yemen 39 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 40 41 although not all were really punishable by death at the time 42 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 43 for intentional maiming the bill specified literal eye for an eye retribution 44 the bill never passed due to the combination of its perceived barbarity in some parts and perceived leniency in others 41 45 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 46 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 47 surgery edit method edit curved knives such as this one were used in the past for some kinds of amputations surgeons performing an amputation have to first 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 and skin and muscle flaps are then transposed over the stump occasionally with the insertion of elements to attach a prosthesis amputation of the leg of first lieutenant antônio carlos de mariz e barros commander of the brazilian 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 48 an experimental technique known as the ewing amputation aims to improve post amputation proprioception 49 50 another technique with similar goals which has been tested in a clinical trial 51 is agonist antagonist myoneural interface ami 52 in 1920 dr janos ertl sr of hungary developed the ertl procedure in order to return a high number of amputees to the workforce 53 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 54 post operative management edit a 2019 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 55 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 56 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 edit traumatic amputation is the partial or total avulsion of a part of a body during a serious accident like traffic labor or combat 57 58 traumatic amputation of a human limb either partial or total creates the immediate danger of death from blood loss 59 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 60 causes edit 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 61 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 62 other rare accidents 63 treatment edit 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 64 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 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 bul...
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