Amputation is the removal of a body extremity by trauma or surgery. As a surgical measure, it is used to control pain or a disease process in the affected limb, such as malignancy or gangrene. In some cases, it is carried out on individuals as a preventative surgery for such problems. A special case is the congenital amputation, a congenital disorder, where foetal limbs have been cut off by constrictive bands. In some countries, amputation of the hands or feet is or was used as a form of punishment for people who committed crimes. Amputation has also been used as a tactic in war and acts of terrorism. In some cultures and religions, minor amputations or mutilations are considered a ritual accomplishment. Unlike many non-mammalian animals (such as lizards that shed their tails), once removed, human extremities do not grow back. A transplant or a prosthesis is the only option for recovering the loss.

Origins of the word

The word "amputation" is derived from the Latin amputare, "to cut away", from ambi- ("about", "around") and putare ("to prune"). The Latin word has never been recorded in a surgical context, being reserved to indicate punishment for criminals. The English word "amputation" was first applied to surgery in the 17th century, possibly first in Peter Lowe's A discourse of the Whole Art of Chirurgerie (published in either 1597 or 1612); his work was derived from 16th century French texts and early English writers also used the words "extirpation" (16th century French texts tended to use extirper), "disarticulation," and "dismemberment" (from the Old French desmembrer and a more common term before the 17th century for limb loss or removal), or simply "cutting", but by the end of the 17th century "amputation" had come to dominate as the accepted medical term.

Overview

The history of human amputation can be divided into a number of periods. Initially, limb loss was usually the result of trauma or 'nonsurgical' removal. This was followed by the hesitant beginnings of surgical intervention, mainly on gangrenous limbs or those already terribly damaged, which developed through to surgical amputations around the 15th century; the distinction is marked by the choice of the patient and the aim of saving a life and achieving a healed stump, despite the difficulties with infection and the lack of effective control for pain or blood loss. Improvements in surgical techniques were married with better haemorrhage control in the 19th century and in the 1840s with anaesthesia and around twenty years later efficient infection control. The 20th century noted marked improvements in surgical techniques and also a move to increasingly sophisticated prosthetic limbs.

Types

Types of amputation include:

• leg
• amputation of digits
• partial foot amputation (Chopart, Lisfranc)
• ankle disarticulation (Syme, Pyrogoff)
• below-knee amputation (transtibial)
• knee-bearing amputation (knee disarticulation)
• above knee amputation (transfemoral)
• Van-ness rotation/rotationplasty (Foot being turned around and reattached to allow the ankle joint to be used as a knee.)
• hip disarticulation
• hemipelvectomy
• arm
• amputation of digits
• metacarpal amputation
• wrist disarticulation
• forearm amputation (transradial)
• elbow disarticulation
• above-elbow amputation (transhumeral)
• shoulder disarticulation and forequarter amputation
• Krukenberg procedure
• teeth
• The avulsion of some teeth (mainly incisives) is or was practiced by some cultures for ritual purposes (for instance in the Iberomaurusian culture of Neolithic North Africa).