Traumatic Amputation

Traumatic amputation is a serious medical condition that occurs when part or all of a limb (or other body part) is removed as a result of mechanical force. It can occur as a result of a rail injury, being run over by a train or tram wheel, a limb being pulled into moving parts of machinery, a large load falling on it, or wartime mine-explosive wounds.

There are complete and incomplete traumatic amputations. With the latter, the severed part of the limb remains connected to the stump with a flap of skin, muscle or tendon. Skin and bone are the most resistant to injury, so muscles, blood vessels and nerves are crushed in the remaining part of the limb over a greater extent than can be judged by the appearance of the skin wound. The skin of the stump is often peeled off over a large area irradiated by the wound.

Extensive destruction of soft tissue and bone of the stump is characteristic of heavy impact, as well as of rail trauma. Avulsion is characterized by separation of segment elements at different levels: for example, the stumps of nerves and blood vessels can be located significantly proximal to the wound. Overstretched or crushed main vessels of the stump are, as a rule, thrombosed, only the muscle branches and bone vessels bleed. The stump wound is usually heavily contaminated.

The most common and dangerous complication of traumatic amputation is traumatic shock. The more proximal the level of traumatic amputation, the more severe it is. The most severe, often irreversible shock occurs when both hips are amputated. Frequent other injuries to the extremities and internal organs also influence the severity of shock. Damage to the latter can dominate the clinical picture and determine the prognosis.

The most common purulent-septic complications are: purulent-necrotic process in the wound of the stump, osteomyelitis, less often sepsis, anaerobic infection in the stump, tetanus. To diagnose traumatic amputation, the mechanism of injury, the time elapsed since the injury, the severity of the general condition, the approximate amount of blood loss (based on the amount of blood at the scene and on clothing), and a preliminary diagnosis of possible other injuries are assessed.

The latter is especially relevant when there is a discrepancy between the clinical picture, the severity of the shock, the level of amputation and the type of stump. The occurrence of severe shock during traumatic amputation of the distal segments of the limb without crushing the tissues of the stump always makes one suspect the presence of damage to other locations.

Treatment of traumatic amputation should be comprehensive and multidisciplinary. Patients with traumatic amputation require immediate medical attention and stabilization of vital functions. It is important to ensure adequate analgesia and bleeding control. Further treatment depends on the severity of the injury and the presence of complications.

One method of treating traumatic amputation is the early prophylactic use of antibiotics. This allows you to prevent the development of infectious complications and reduce the risk of complications in the perioperative period.

Surgical treatment of traumatic amputation may include revascularization or reconstructive surgery. Revascularization allows limb preservation by restoring blood supply. Reconstructive surgery may include tissue grafts, bone grafts, or prosthetic implants.

After surgical treatment, patients with traumatic amputation need rehabilitation and prevention of complications. Rehabilitation activities may include physical therapy, occupational therapy, psychological support and assistance in adapting to new living conditions.

Thus, traumatic amputation is a serious medical condition that requires immediate medical attention and comprehensive treatment. Early diagnosis and treatment of complications can significantly increase the chances of restoring health and adapting to new living conditions.