Amputation



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. In Islamic countries, amputation of the hands or feet is sometimes used as a form of punishment for criminals. In some cultures and religions, minor amputations or mutilations are considered a ritual accomplishment.

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 (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
 * 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).

Hemicorporectomy, or amputation at the waist, is the most radical amputation.

Genital modification and mutilation may involve amputating tissue, although not necessarily as a result of injury or disease.

As a rule, partial amputations are preferred to preserve joint function, but in oncological surgery, disarticulation is favored.

Method
The first step is ligating the supplying artery and vein, to prevent hemorrhage. The muscles are transsected, and finally the bone is sawed through with an oscillating saw. Skin and muscle flaps are then transposed over the stump, occasionally with the insertion of elements to attach a prosthesis. In a disarticulation amputation, the bone is removed at the joint.

Self-amputation
In some rare cases when a person has become trapped (on account of getting a limb stuck) in a deserted place, with no means of communication or hope of rescue, the victim has amputated his own limb:
 * In 2003, 27-year old Aron Ralston amputated his forearm using his pocketknife and breaking and tearing the two bones, after the arm got stuck under a boulder when hiking in Utah.
 * Also in 2003, an Australian coal miner amputated his own arm with a Stanley knife after it became trapped when the front-end loader he was driving overturned three kilometers underground.

Even rarer are cases where self-amputation is performed for criminal or political purposes:
 * It is alledged that some residents of Vernon, Florida threatened to kill documentary film maker Errol Morris, who was going to expose a bizarre scam wherein individuals would cut off their own limbs as a way to collect insurance money.
 * On March 7, 1998, Daniel Rudolph, the elder brother of the 1996 Olympics bomber Eric Robert Rudolph, videotaped himself cutting off one of his own hands with an electric saw in order to "send a message to the FBI and the media."

After-effects
Some amputees experience the phenomenon of phantom limbs ; they feel body parts that are no longer there. These limbs can itch, ache, and feel as if they are moving. Some scientists believe it has to do with a kind of neural map that the brain has of the body, which sends information to the rest of the brain about limbs regardless of their existence. Phantom sensations and phantom pain may also occur after the removal of body parts other than the limbs, e.g. after amputation of the breast, extraction of a tooth (phantom tooth pain) or removal of an eye (phantom eye syndrome).

In many cases, the phantom limb aids in adaptation to a prosthesis, as it permits the person to experience proprioception of the prosthetic limb.

Another side-effect can be heterotopic ossification, especially when a bone injury is combined with a head injury. The brain signals the bone to grow instead of scar tissue to form, and nodules and other growth can interfere with prosthetics and sometimes require further operations. This type of injury has been especially common among soldiers wounded by IEDs in the occupation of Iraq.