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AMPUTATION

Amputation can occur for a variety of reasons. Vascular disease and infection account for 70%. Other categories include: trauma (22%), tumor (5%) and congenital deformity (3%). The estimation of amputees living in the United States is 1,230,000. There are about five times as many lower extremity amputees as compared to upper extremity amputees.

After stabilization following amputation, prosthetic restoration can begin. The physiatrist (a physician specializing in physical medicine and rehabilitation) can perform an evaluation and initiate the process. A prescription is written describing the process. The prosthetist uses this as a guide in fabricating the artificial limb.

Lower extremity prostheses consist of a suspension device, a socket (to contain the end of the residual limb), rigid components and a terminal device (foot). A temporary prosthesis is often made for use in the more immediate post-surgical period. During this time, the residual limb undergoes shrinkage and will assume its final shape. This is usually three to six months after surgery.

In the last 10 years, significant advances in upper extremity prostheses have occurred. There now exists a vast array of prosthetic components (prosthetic terminal devices, wrists, elbows and shoulders) for upper limb restoration. It can be a very challenging task to obtain the proper components for an individual patient. An expert team devoted to the amputee patient should include a surgeon, physiatrist, occupational therapist, physical therapist, psychologist, social worker, the patient and family.

The details of the surgical procedure, the prosthesis, the rehabilitation and expectations, both physical and mental, can be addressed by this team. The patient moves through various phases of rehabilitation from pre-surgical counseling to long term follow-up. The physiatrist has an understanding of each team member’s role, and can work with the patient and team through these various stages.

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