Amputation – an irreversible change

The loss of a part of the body is one of the most invasive interventions in the body that one can experience. No matter if it is an arm or a leg to be amputated, it is never easy. But it may be a bit easier if one accepts help and advice.

"When I woke up from a coma of three days, I saw that my arm was gone. I only wanted to sleep again. I've persuaded myself that everything will be fine; I’m only dreaming," says Katharina about her first conscious thought after the accident.

Falling asleep, waking up and everything is as it was before – the wish of many freshly amputated people. But unfortunately, an amputation is an irrevocable physical change. Any minor amputation of a limb means a loss of a differentiated part of the body of the patient and, consequently the loss of his/her physical integrity. "The loss of a limb is equivalent to the loss of a close relative," says Dagmar Gail, chairman and founder of the Amputierten-Initiative e.V (Amputees Initiative) in Germany. Even the most sophisticated technology is not able to fully replace this loss with prosthesis.

Reasons for amputation

There are different causes that can lead to amputation. It is essential whether the person can prepare for years during an illness before the amputation, or whether the loss of a limb is caused by a traumatic event.

The most common reason for amputation of the lower extremities are vascular diseases. Other causes are, for example, diabetes, accidents or cancer. Amputations of the upper extremities are about 17 times rarer. The most common cause is trauma.

The number of amputations can only be estimated both in Germany and Switzerland. A register of amputations does not exist. The number of leg amputations in Germany is approximately 60,000 per year. Amputations worldwide are significantly increasing due to the increase of disorders like diabetes mellitus and arterial occlusive diseases.
"This is related to the increase in life expectancy and our eating habits," says Thomas Böni, Senior Consultant at the University Hospital Balgrist, Switzerland.

Good preparation helps to heal

If someone has the chance to prepare for an amputation, this time before the operation should be used as efficiently as possible so that the healing and rehabilitation can optimally process.

It is important to take into account both the physical and the psychological aspects that arise with a medical intervention. It is important to be informed early by the attending physician about the process and the consequences of the surgery. All questions about the surgical procedure, the treatment and possible prosthesis should be answered and any uncertainties relating to business and private life clarified.

Relatives should be involved in the entire process of the amputation. They are very important and can actively support the patient both morally and practically.

As an additional source of information and support, other people with amputations and self-help groups  may be consulted. Fear, anxiety and uncertainty can be reduced by the personal experiences of people with amputations. However, it must be clear that the treatment process is individual and direct comparisons with other patients are not possible.

Finding the right attitude to amputation

An important point is the personal attitude of the patient towards the amputation. The amputation should be viewed as a positive step towards improvement or stabilisation of health. The recovery and rehabilitation can only be successful if the patient is actively involved in the entire process.

If there is no preparation phase possible, Dr. Thomas Böni advises to immediately talk to other affected persons after the amputation, as early as possible. This can give a positive perspective on life. Equally important is psychological or psychiatric support and good attending staff that can inspire security and confidence without arousing unrealistic hopes.

The before and after

"Patients feel often anxious before an amputation and sometimes very depressed. Once the trust to doctor and treatment team is build up, the mood will lift," says Thomas Böni. After the surgery, the pains and questions about the "new" life are to the fore. “First of all, I had to deal with the pain. Only later it occurred to me: What I can do what not," says Manfred M.  about his amputation after a car accident.

"For many patients, the imagination is worse than the reality, and they quickly learn to cope with the new situation surprisingly well. Other people need a little more time and can, for example, not yet look at the stump at the beginning during changing the dressing. With patience and affection, the patient can usually accept his condition soon. It is important that we and the relatives can accept the patient as a full person; this transfers to the patient and his/her self-esteem," says amputation surgeon Thomas Böni.

The time between surgery and prosthetic adjustment

For most affected people, the process between surgery and adjustment of prostheses is particularly exhausting and tedious.

Affected people face a variety of changes after the amputation. In addition to the physical function limitations, developments in the psychosocial field play a crucial role. Often, changes in professional and family environment have to be processed.

In this phase, many specialists are working together to ensure the most possible mobility and flexibility for the patient. In addition to these physical activities, the psychological rehabilitation and social situation also play essential roles.

The majority of amputees experiences stump pains or phantom pains during this phase. Stump pains are caused by processes that are localised in the stump itself. Phantom pains can occur after the removal or denervation of a limb. They take on different pain characteristics and are triggered by various factors. Phantom sensations are sensations in the area of the no longer existing limbs.

“If possible, patients must be informed about the risk of phantom pains even before the amputation. We expect about 10% therapy refractory phantom pains, which are a real problem. A good preoperative and postoperative pain management is important. Today, there are powerful drugs to combat phantom pains, along with those drugs, an early activity with the stump is important," explains the Senior Consultant Thomas Böni.

There is no formula for coping with an amputation

Each affected person overcomes amputation differently. Personality factors, social environment and previous life events are of great importance the processing of an amputation.

Manfred M. and Katharina S., both amputated after car accidents, answered the most important questions for you that occur after an amputation.

Read the full interviews here:

Amputation of lower leg

Amputation of arm


Text: MHA

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