Introduction
An amputation, i.e. the removal of a limb, can have many different causes. A distinction is made between an amputation injury, e.g. in an accident, and an amputation that becomes necessary due to another illness. The causes of an amputation are varied, as are the amputation sites.
If the lower leg has to be surgically removed, the cause is usually diabetes mellitus; if it affects the upper extremity, accidents are more common. On the one hand, the causes can be in the traumatological area – i.e. accident as the cause. After injuries, e.g. in a car accident with severe damage to a limb, it is often no longer possible to preserve the injured body part.
A septic cause can be an uncontrollable infection, e.g. after an accident (trauma) or a pathological tissue loss (wet gangrene). However, amputation may also be necessary in the case of tumour diseases. In the case of uncontrollable, malignant soft tissue or bone tumours in the area of the arms or legs (extremities), surgical removal may sometimes be unavoidable in order to prevent the tumour from progressing or even spreading.
But amputation can also be helpful due to a severe functional limitation, such as a rigid and curved finger, which impairs the mobility of the hand and the other fingers, although this may not sound right at first sight. However, the functional impairment can be so severe that amputation of one finger may be appropriate. – of the skin soft tissue mantle
- Of the blood circulation
- And the skeleton
Common causes of amputation
Angiological causes, i.e. vascular diseases, are among the most common reasons for amputation. Irrecoverable circulatory disorders with loss of soft tissue around larger blocked vessels due to calcification and narrowing of the arteries (arteriosclerosis) or blockage due to a blood clot (embolism) are usually the cause. In diabetics, the diabetic foot syndrome is often the reason for amputation.
The peripheral neuropathy associated with the disease leads to nerve damage, which is accompanied by sensory disturbances or even sensations in the legs. The damage progresses slowly from the foot to the thigh. Together with the sensory disturbance, there is also a reduced pain sensation, which means that even under extreme stress the affected person does not feel any pain, which is actually perceived by the body as a warning symptom of tissue loss.
The consequence of this lack of sensation is that incorrect pressure loads or incorrect footwear can lead to skin defects (ulcers) which are only noticed at a later stage. The same applies to burns. Untreated skin lesions become inflamed, bacteria can settle and can lead to massive changes with destruction of soft tissue and bone tissue.
In addition to peripheral neuropathy, diabetics often suffer from peripheral arterial occlusive disease or diabetic microangiopathy, i.e. calcification of the small vessels. Calcification of the vessels, which leads to a limited supply of oxygen and nutrients to the legs, means that adequate tissue supply cannot be guaranteed under critical conditions such as pressure loads or injuries. As a result, wound healing disorders with tissue loss (moist gangrene) occur, which can lead to complete death of the toes and later of the overlying tissue.
In diabetic patients, two different processes in the body lead to the death of parts of the body which have to be amputated. Due to the permanently high blood sugar in poorly adjusted diabetics, damage to the blood vessels occurs. Defense cells altered by sugar form plaques in the vessels and block the blood vessels.
The areas of the body behind the plaques are no longer supplied with sufficient oxygen and die. Since undersupplied body areas form a breeding ground for bacteria, dead areas must be amputated generously. In addition to the blood vessels, the nerves are also damaged.
Damaged nerves lead to a reduced sensitivity to pain in the feet. Small wounds, for example from badly fitting shoes, are not noticed and spread. In combination with the poor blood circulation, this leads to wound healing disorders and infections, which in turn may make amputation necessary.
For those affected, one operation is often not enough, but the feet are gradually amputated further. Prevention can only be achieved through consistent blood sugar regulation and regular foot care. The diabetic foot is one of the most common reasons for amputations in Germany.
Every cell in our body needs oxygen to survive. This oxygen is transported to the cells via the blood vessels. If this transport route is blocked, the area behind the blockage dies.
Circulatory disorders can have very different causes. In the case of diabetes or high cholesterol levels, the blood vessels throughout the body are damaged and plaque forms in the vessels. Thrombi then form at these narrow points, which can be flushed into smaller vessels and remain there.
Some infectious diseases also cause thrombus formation, which may make amputations necessary. Some people also have congenital blood clotting disorders. This means that the blood forms clots on its own and lays down vessels.
One of the most common causes of thrombi is a cardiac dysrhythmia called atrial fibrillation. In this condition, the atria contract uncontrollably and the altered flow in the heart leads to blood clotting. These thrombi can cause strokes, heart attacks or even vascular occlusions in the legs and arms.
If the treatment is too late, they must be amputated. This can often be prevented by timely treatment. The first thing that most people think of when amputating is a serious accident.
These are probably among the most extreme cases, as there is no disease and the amputation is a sudden event. Fortunately, amputations after accidents are not the rule. Even limbs that have already been separated from the body by the accident can be reattached.
On the one hand, there are patients who lose limbs due to the accident which cannot be reattached. These are so-called amputation injuries. On the other hand, there are severe injuries in which the tissue is so badly damaged that surgical amputation is necessary.
Added to this are possible infections after an accident, especially if the wound has been contaminated. Amputations after accidents often have a good prognosis for residual limb healing and thus the possibility of wearing prostheses, since the body is healthy in itself and not, as with circulatory disorders, merely shifts the problem. Close psychological support of the affected persons is important, as they are suddenly thrown into a completely new life situation.
Traffic accidents or deep cuts in the kitchen often affect the fingers. If it is no longer possible to preserve the finger, it must be amputated. The loss of a finger usually affects the affected person more than an amputated toe.
After small injuries, for example during gardening, bacteria can get into the wound and cause major inflammation. In some cases, the spread of the inflammation can only be prevented by amputation. This is especially the case with resistant germs.
An extreme example of an infection is the gas fire. Through wounds, especially bruises, with severe tissue damage, the environmental germs called Clostridium perfringens penetrate the skin. The bacteria eat their way through the tissue and destroy blood vessels.
A life-threatening spread of the germ can only be prevented by a large-scale amputation. Even germs that affect the whole body can make amputations necessary due to the formation of thrombi. The larger and dirtier a wound is, the more likely it is to be contaminated with dangerous bacteria.
Especially after serious accidents, animal bites and burns, the risk of infection is increased. There are many pathogens in cat saliva, which can lead to severe inflammation and infection even in small bite wounds and thus make amputation necessary. For these reasons, even small wounds should be checked by your family doctor.
In this case, the tetanus vaccination protection must also be considered. An amputation is always the last resort and is only used if the life of the person concerned is in danger. Normally, bites from insects, such as mosquitoes or wasps, do not lead to major infections.
In some cases, however, an allergy can lead to more serious consequences than the normal wheal. If the bacterium Streptococcus pyogenes is transmitted during the bite, it can lead to a so-called necrotising fasciitis. This means that the sheath of the muscles becomes inflamed and dies off.
The blood vessels are compressed by the swelling and amputation may be necessary. However, this severe course is very rare.