The surgical removal of a hand or arm means both a major medical procedure and significant changes that affect adjustment to daily life. Knowing what to expect in this process and how to prepare can make adjustment easier. The following information is general; the guide that takes a holistic look at the general course of living with amputation describes this process in a broader framework, and every intervention is planned individually in line with the specialist physician's assessment and medical report.
Why May Amputation Be Necessary?
Amputation is the surgical removal of a part of the body and may be considered for many different reasons. A physician generally decides on amputation when they identify a problem in the limb that does not appear able to heal or that could endanger life if the limb is not removed. Common reasons may include the following:
- Severe injuries that the body cannot repair (for example, due to a major accident)
- Conditions such as diabetes that make wound healing difficult
- Peripheral artery disease or other circulatory diseases that block blood flow to the limbs
- Some cancers that develop in muscle or bone
- Infections that damage the limb and spread through the bloodstream
Amputation Levels
Where and how the limb will be removed is called the "amputation level" and is determined by several factors: the location of the damage, the cause of the damage, how much of the remaining (residual) limb can be preserved, and the area that will heal most quickly and most safely. The chosen level also affects which prosthetic solutions will be suitable later on and when a prosthesis will come into consideration. The main levels are the following:
- Partial hand or finger amputation: Removal of a part below the wrist; the wrist joint is generally preserved.
- Wrist disarticulation: The hand is removed at the wrist joint; most people can use a prosthesis attached to the forearm.
- Transradial amputation: The hand and part of the forearm are removed; the length of the remaining forearm may vary.
- Elbow disarticulation: The entire forearm is removed at the elbow joint; the upper arm is preserved.
- Transhumeral amputation: The arm is removed through the middle of the upper arm bone (humerus).
- Shoulder disarticulation: The entire arm is removed at the shoulder joint.
- Forequarter amputation: The arm, the shoulder joint, the shoulder blade and part of the collarbone are removed.
In determining the appropriate level and the subsequent prosthetic plan, the assessment of a prosthetist may be drawn on under the physician's guidance.
Preoperative Assessment
Before a planned amputation, the physician explains in detail the type of amputation required, what the process will involve and how recovery will progress. Taking notes and asking questions in these discussions helps in understanding the process better. A comprehensive preoperative assessment is also carried out; this generally includes blood tests, radiological examinations and tests that assess the condition of the heart and lungs.
Physical Preparation
Before the procedure, the care team may show some exercises that will make recovery easier. These activities help strengthen the muscles and are generally planned individually by a physiotherapist. The opinion of a prosthetist may also be obtained on which exercises are appropriate in preparation for a prosthetic device.
Mental Preparation and Support
Preparation is not only physical but also psychological. It may be useful to use the time before the procedure to prepare mentally. There are various ways of getting support:
- Talking about fears and concerns with a trained mental health professional
- If faith is important, meeting with a religious leader
- Managing daily stress by making use of evidence-based mental health practices
Reaching the right support early can make it easier to cope with the anxiety and uncertainty that the process naturally brings. Connecting with people who have had a similar experience or with support groups may also contribute to the adjustment process; a referral for this can be requested from the care team.
This content is for informational purposes only; you should consult your physician for diagnosis and treatment.
