Editing Amputation

{{Short description|Medical procedure that removes a part of the body}}
{{Use mdy dates|date=April 2025}}
{{Infobox medical condition
| name            = Amputation
| image           = Flickr_-_The_U.S._Army_-_U.S._Army_World_Class_Athlete_Program_Paralympic.jpg
| caption         = An amputee running with a blade prosthetic
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| field           = [[Surgery]]
[[Physical medicine and rehabilitation]]
[[Emergency medicine]]
| symptoms        =
| complications   = [[Phantom limb syndrome]]
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| causes          = [[Major trauma|Trauma]] or intentional as part of [[surgery]] and sometimes [[corporal punishment]].
| risks           =
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{{corporal punishment}}
{{Criminal procedure (trial)}}

'''Amputation''' is the removal of a [[Limb (anatomy)|limb]] or other body part by [[Physical trauma|trauma]], [[medical illness]], or [[surgery]]. As a surgical measure, it is used to control pain or a disease process in the affected limb, such as [[cancer|malignancy]] or [[gangrene]]. In some cases, it is carried out on individuals as a [[Preventive healthcare|preventive surgery]] for such problems. A special case is that of [[congenital amputation]], a [[congenital disorder]], where [[fetus|fetal]] limbs have been cut off by constrictive bands. In some countries, judicial amputation is currently used [[punishment|to punish]] people who commit crimes.<ref name="iran">{{Cite news |last=Fathi |first=Nazila |date=2008-01-11 |title=Spate of Executions and Amputations in Iran |work=[[The New York Times]] |url=https://www.nytimes.com/2008/01/11/world/middleeast/11iran.html |url-access=limited |access-date=2021-06-27}}</ref><ref name="Chuback 2005">{{Cite conference |last=Chuback |first=Jennifer E. |date=March 2005 |editor-last=Whitelaw |editor-first=W. A. |title=The history of rhinoplasty |url=https://www.researchgate.net/publication/16854023 |conference=14th Annual History of Medicine Days |publisher=[[University of Calgary]] |publication-place=Calgary, Alberta, Canada |pages=10–15 |via=[[ResearchGate]]}}</ref><ref>{{Cite journal|last=Kocharkarn|first=Wachira | name-list-style = vanc |date=Summer 2000|title=Traumatic amputation of the penis|url=http://brazjurol.com.br/pdf/kochakarn_385_389.pdf |archive-url=https://ghostarchive.org/archive/20221009/http://brazjurol.com.br/pdf/kochakarn_385_389.pdf |archive-date=2022-10-09 |url-status=live|journal=Brazilian Journal of Urology|volume=26|pages=385–389|via=Official Journal of the Brazilian Society of Urology}}</ref><ref>{{Cite book|url=https://books.google.com/books?id=Im95I7FjrvwC&q=amputation+punishment&pg=PR7|title=Crime and Punishment in Islamic Law: Theory and Practice from the Sixteenth to the Twenty-First Century|last=Peters|first=Rudolph| name-list-style = vanc |date=2005|publisher=Cambridge University Press|isbn=9780521792264 }}</ref> Amputation has also been used as a tactic in war and acts of terrorism; it may also occur as a war injury. In some cultures and religions, minor amputations or [[mutilation]]s are considered a ritual accomplishment.<ref>{{cite journal | vauthors = Bosmia AN, Griessenauer CJ, Tubbs RS | title = Yubitsume: ritualistic self-amputation of proximal digits among the Yakuza | journal = Journal of Injury and Violence Research | volume = 6 | issue = 2 | pages = 54–56 | date = July 2014 | pmid = 24284812 | pmc = 4009169 | doi = 10.5249/jivr.v6i2.489 }}</ref><ref>{{cite journal | vauthors = Kepe T | title = 'Secrets' that kill: crisis, custodianship and responsibility in ritual male circumcision in the Eastern Cape Province, South Africa | journal = Social Science & Medicine | volume = 70 | issue = 5 | pages = 729–735 | date = March 2010 | pmid = 20053494 | doi = 10.1016/j.socscimed.2009.11.016 }}</ref><ref>{{cite journal | vauthors = Grisaru N, Lezer S, Belmaker RH | title = Ritual female genital surgery among Ethiopian Jews | journal = Archives of Sexual Behavior | volume = 26 | issue = 2 | pages = 211–215 | date = April 1997 | pmid = 9101034 | doi = 10.1023/a:1024562512475 | s2cid = 32053425 }}</ref> When done by a person, the person executing the amputation is an amputator.<ref>{{Cite encyclopedia |title=Amputator |encyclopedia=[[Merriam-Webster]] |url=https://www.merriam-webster.com/dictionary/amputator |access-date=28 June 2021}}</ref><ref>{{Cite encyclopedia |title=Amputee |encyclopedia=[[Merriam-Webster]] |url=https://www.merriam-webster.com/dictionary/amputee |access-date=28 June 2021}}</ref> The oldest evidence of this practice comes from a skeleton found buried in Liang Tebo cave, [[East Kalimantan]], Indonesian [[Borneo]] dating back to at least 31,000 years ago, where it was done when the amputee was a young child.<ref>{{cite journal|last1=Maloney|first1=T.R.|last2=Dilkes-Hall|first2=I.E.|last3=Vlok|first3=M|title=Surgical amputation of a limb 31,000 years ago in Borneo|journal=Nature|issue=7927|pages=547–551|year=2022|volume=609 |doi=10.1038/s41586-022-05160-8|pmid=36071168 |pmc=9477728 |bibcode=2022Natur.609..547M }}</ref> A [[prosthesis]] or a [[Bioelectronics|bioelectric replantation]] restores sensation of the amputated limb.

==Types==
{{more citations needed section|date=June 2021}}

=== Leg ===
Lower limb amputations can be divided into two broad categories: minor and major amputations. Minor amputations generally refer to the amputation of [[toe|digits]]. Major amputations are commonly below-knee- or above-knee amputations. Common partial foot amputations include the [[François Chopart|Chopart]], [[Tarsometatarsal articulations|Lisfranc]], and ray amputations.

Common forms of ankle [[disarticulation]]s include Pyrogoff, Boyd, and Syme amputations.<ref>{{cite journal | vauthors = Pinzur MS, Stuck RM, Sage R, Hunt N, Rabinovich Z | title = Syme ankle disarticulation in patients with diabetes | journal = The Journal of Bone and Joint Surgery. American Volume | volume = 85 | issue = 9 | pages = 1667–72 | date = September 2003 | pmid = 12954823 | doi = 10.2106/00004623-200309000-00003 }}</ref> A less common major amputation is the [[Van Nes rotation]], or rotationplasty, i.e. the turning around and [[replantation|reattachment]] of the foot to allow the ankle joint to take over the function of the knee.

Types of amputations include:
[[File:Diagram showing an above knee amputation CRUK 094.svg|thumb|upright=1.1|An above-knee amputation]]
; partial foot amputation: amputation of the lower limb distal to the ankle joint
; ankle disarticulation: amputation of the lower limb at the ankle joint
; {{anchor|BTK}}trans-tibial amputation: amputation of the lower limb between the knee joint and the ankle joint, commonly referred to as a below-knee amputation
; {{anchor|BKA}}knee disarticulation: amputation of the lower limb at the knee joint
; trans-femoral amputation: amputation of the lower limb between the hip joint and the knee joint, commonly referred to an above-knee amputation
; hip disarticulation: amputation of the lower limb at the hip joint
; trans-pelvic disarticulation: amputation of the whole lower limb together with all or part of the pelvis, also known as a [[hemipelvectomy]] or hindquarter amputation

===Arm===
[[File:Amputations 18c.jpg|thumb|250px|The 18th century guide to amputations]]Types of upper extremity amputations include:
* partial hand amputation
* wrist disarticulation
* trans-radial amputation, commonly referred to as below-elbow or forearm amputation
* elbow disarticulation
* trans-humeral amputation, commonly referred to as above-elbow amputation
* shoulder disarticulation
* [[forequarter amputation]]
A variant of the trans-radial amputation is the [[Krukenberg procedure]] in which the radius and ulna are used to create a stump capable of a pincer action.

===Other===
[[File:Index finger amputation.jpg|thumb|Partial amputation of [[index finger]]]]
* Facial amputations include but are not limited to:
** amputation of the ears
** amputation of the nose ([[rhinotomy]])
** amputation of the tongue ([[glossectomy]])
** amputation of the eyes ([[enucleation of the eye|enucleation]])
** amputation of the teeth ([[Dental evulsion]]). Removal of teeth, mainly incisors, is or was practiced by some cultures for ritual purposes (for instance in the [[Iberomaurusian]] culture of [[Prehistoric Central North Africa|Neolithic North Africa]]).
* Breasts:
** amputation of the breasts ([[mastectomy]])
* [[Genitals]]:
** amputation of the testicles ([[orchiectomy]])
** amputation of the penis ([[penectomy]])
** amputation of the [[foreskin]] ([[circumcision]])
** amputation of the clitoris ([[clitoridectomy]])
** amputation of the vulva ([[vulvectomy]])
* Radicals:
** Amputation of the waist ([[hemicorporectomy]])
** Amputation of the head ([[decapitation]])

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

[[Laryngectomy]] is the amputation of the larynx.

===Self-amputation===
{{See also|Autotomy|Body integrity identity disorder}}

In some rare cases when a person has become trapped in a deserted place, with no means of communication or hope of rescue, the victim has amputated their own limb. The most notable case of this is [[Aron Ralston]], a hiker who had amputated his own right forearm after it was pinned by a boulder in a hiking accident and he was unable to free himself for over five days.<ref>{{Cite news |last=Ransom |first=Cliff |date=24 July 2003 |title=Did Climber Have to Cut Off Arm to Save Life? |work=National Geographic |url=https://www.nationalgeographic.com/culture/article/climber-ralston-amputate-arm-utah/ |archive-url=https://web.archive.org/web/20190106010831/https://www.nationalgeographic.com/culture/2003/07/climber-ralston-amputate-arm-utah/ |url-status=dead |archive-date=January 6, 2019 |access-date=5 January 2019}}</ref>

[[Body integrity identity disorder]] is a psychological condition in which an individual feels compelled to remove one or more of their body parts, usually a limb.  In some cases, that individual may take drastic measures to remove the offending appendages, either by causing irreparable damage to the limb so that medical intervention cannot save the limb, or by causing the limb to be severed.<ref>{{Cite journal |last=Müller |first=Sabine |date=2009-01-05 |title=Body Integrity Identity Disorder (BIID)—Is the Amputation of Healthy Limbs Ethically Justified? |url=http://www.tandfonline.com/doi/abs/10.1080/15265160802588194 |journal=The American Journal of Bioethics |language=en |volume=9 |issue=1 |pages=36–43 |doi=10.1080/15265160802588194 |pmid=19132621 |issn=1526-5161}}</ref>

===Urgent===
In [[surgery]], a '''guillotine amputation''' is an amputation performed without closure of the skin in an urgent setting.<ref name=GuilAnk>{{cite journal|last1=Panchbhavi|first1=Vinod K|title=Guillotine Ankle Amputation|url=http://emedicine.medscape.com/article/1894411-overview|website=Medscape|date=8 June 2021}}</ref> Typical indications include catastrophic trauma or infection control in the setting of [[infected gangrene]].<ref name=GuilAnk/> A guillotine amputation is typically followed by a more time-consuming, definitive amputation such as an [[above knee amputation|above or below knee amputation]].<ref name=GuilAnk/>

==Causes==

===Circulatory disorders===
* [[Diabetes|Diabetic]] vasculopathy
* [[Sepsis]] with peripheral necrosis
* [[Peripheral artery disease]] which can lead to [[gangrene]]
* A severe [[deep vein thrombosis]] ([[phlegmasia cerulea dolens]]) can cause [[compartment syndrome]] and gangrene<ref name=Compartment>{{cite journal | vauthors = Abdul W, Hickey B, Wilson C | title = Lower extremity compartment syndrome in the setting of iliofemoral deep vein thrombosis, phlegmasia cerulea dolens and factor VII deficiency | journal = BMJ Case Reports | volume = 2016 | date = April 2016 | pages = bcr2016215078 | pmid = 27113791 | pmc = 4854131 | doi = 10.1136/bcr-2016-215078 }}</ref>

===Neoplasm===
[[Image:1daypost.jpg|thumb|right|Transfemoral amputation due to [[liposarcoma]]]]
* Cancerous bone or soft tissue tumors (e.g. [[osteosarcoma]], [[chondrosarcoma]], [[fibrosarcoma]], [[epithelioid sarcoma]], [[Ewing's sarcoma]], [[synovial sarcoma]], [[sacrococcygeal teratoma]], [[liposarcoma]]), [[melanoma]]<ref>{{Citation |last1=Ragnarsson |first1=Kristjan T. |title=Cancer of the Limbs |date=2003 |url=https://www.ncbi.nlm.nih.gov/books/NBK13778/ |work=Holland-Frei Cancer Medicine. 6th edition |access-date=2024-01-09 |publisher=BC Decker |language=en |last2=Thomas |first2=David C.}}</ref>

===Trauma===
[[Image:World War I radiography amputee.jpg|thumb|Three fingers from a soldier's right hand were traumatically amputated during [[World War I]].]]
* Severe limb [[injury|injuries]] in which the efforts to save the limb fail or the limb cannot be saved.
* [[Physical trauma|Traumatic]] amputation (an unexpected amputation that occurs at the scene of an accident, where the limb is partially or entirely severed as a direct result of the accident, for example, a finger that is severed from the blade of a table saw)
* Amputation in utero ([[Amniotic band]])

===Congenital anomalies===
* Deformities of digits and/or limbs (e.g., [[proximal femoral focal deficiency]], [[Fibular hemimelia]])
* Extra digits and/or limbs (e.g., [[polydactyly]])

===Infection===
{{columns-list|colwidth=25em|
* [[Animal bite]]s
* [[Bubonic plague]]
* [[Diabetic foot infection]]s
* [[Gangrene]]
* [[Gas gangrene]]
* [[Influenza A Virus]]
* ''[[Legionella]]''
* [[Meningococcal meningitis]]
* [[Necrosis]]
* [[Necrotizing fasciitis]]
* [[Osteomyelitis]] (bone infection)
* [[Sepsis]]
* ''[[Streptococcus]]''
* [[Trench foot]]
* ''[[Vibrio vulnificus]]''
}}

=== Frostbite ===

[[Frostbite]] is a cold-related injury occurring when an area (typically a limb or other extremity)<ref>{{Cite web |date=2017-10-19 |title=Frostbite |url=https://www.nhs.uk/conditions/frostbite/ |access-date=2022-06-29 |website=nhs.uk |language=en}}</ref> is exposed to extreme low temperatures, causing the freezing of the skin or other tissues.<ref name="handford2017">{{Cite journal |last1=Handford |first1=Charles |last2=Thomas |first2=Owen |last3=Imray |first3=Christopher H. E. |date=2017-05-01 |title=Frostbite |url=https://www.sciencedirect.com/science/article/pii/S0733862716301201 |journal=Emergency Medicine Clinics of North America |series=Wilderness and Environmental Medicine |language=en |volume=35 |issue=2 |pages=281–299 |doi=10.1016/j.emc.2016.12.006 |pmid=28411928 |issn=0733-8627|url-access=subscription }}</ref> Its [[pathophysiology]] involves the formation of ice crystals upon freezing and [[blood clot]]s upon thawing, leading to [[cell damage]] and [[cell death]].<ref name="handford2017" /> Treatment of severe frostbite may require surgical amputation of the affected tissue or limb;<ref>{{Cite journal |last1=Handford |first1=Charles |last2=Buxton |first2=Pauline |last3=Russell |first3=Katie |last4=Imray |first4=Caitlin Ea |last5=McIntosh |first5=Scott E. |last6=Freer |first6=Luanne |last7=Cochran |first7=Amalia |last8=Imray |first8=Christopher He |date=2014 |title=Frostbite: a practical approach to hospital management |journal=Extreme Physiology & Medicine |volume=3 |pages=7 |doi=10.1186/2046-7648-3-7 |issn=2046-7648 |pmc=3994495 |pmid=24764516 |doi-access=free }}</ref> if there is deep injury [[autoamputation]] may occur.<ref>{{Cite web |title=Frostbite Clinical Presentation: History, Physical Examination, Complications |url=https://emedicine.medscape.com/article/926249-clinical |access-date=2022-06-29 |website=emedicine.medscape.com}}</ref>

===Athletic performance===
Sometimes professional [[Sportsperson|athletes]] may choose to have a non-essential digit amputated to relieve chronic pain and impaired performance.
* Australian Rules footballer [[Daniel Chick]] elected to have his left [[ring finger]] amputated as chronic pain and injury was limiting his performance.<ref>{{Cite web |last=Murray |first=Shane |date=2002-01-22 |title=RTE: Aussie Rules star has finger removed |website=[[RTÉ.ie]] |url=http://www.rte.ie/sport/2002/0122/aussierules.html |url-status=dead |archive-url=https://web.archive.org/web/20071214022643/http://www.rte.ie/sport/2002/0122/aussierules.html |archive-date=2007-12-14 |access-date=2007-10-19}}</ref>
* [[Rugby union]] player [[Jone Tawake]] also had a finger removed.<ref>{{cite web |author=Australian Rugby Union |url=http://www.sportsaustralia.com/articles/oct06/artid6659.html |title=Tawake undergoes surgery to remove finger |publisher=SportsAustralia.com |date=2006-10-17 |access-date=2013-04-22 |archive-url=https://web.archive.org/web/20130501093242/http://sportsaustralia.com/articles/oct06/artid6659.html |archive-date=2013-05-01 |url-status=dead }}</ref>
* [[National Football League]] [[Safety (American and Canadian football position)|safety]] [[Ronnie Lott]] had the tip of his little finger removed after it was damaged in the [[1985 NFL season]].<ref>{{Cite magazine|magazine=[[Sports Illustrated]]|title=Ronnie Lott's Amputated Pinkie Finger|first=Robert|last=Klemko|url=https://www.si.com/nfl/2014/06/17/nfl-history-in-95-objects-ronnie-lott-amputated-pinkie-finger|date=2014-06-17|archive-url=https://web.archive.org/web/20220815042211/https://www.si.com/nfl/2014/06/17/nfl-history-in-95-objects-ronnie-lott-amputated-pinkie-finger|archive-date=2022-08-15}}</ref>

=== Criminal penalties ===
{{anchor|Criminal penalty}}
* According to [[Quran 5:38]], the punishment for stealing is the amputation of the hand. Under [[Sharia law]], after repeated offense, the foot may also be cut off. This is still in practice today in countries like [[Brunei]], the [[United Arab Emirates]],<ref>{{Cite web|title=Burglar's hand to be amputated|url=https://gulfnews.com/uae/crime/burglars-hand-to-be-amputated-1.343257|access-date=2021-11-03|website=Gulf News|date=30 December 2004 |language=en}}</ref> [[Iran]],<ref>{{Cite news |date=2010-10-17 |title=Iranian chocolate thief faces hand amputation |work=[[BBC News Online]] |url=https://www.bbc.com/news/world-middle-east-11559750 |access-date=2021-06-28}}</ref><ref name="Telegraph 2008">{{Cite news |last=Dovan |first=Fiona |date=2008-02-09 |title=Iran envoy defends amputation |work=[[The Daily Telegraph|The Telegraph]] |url=https://www.telegraph.co.uk/news/worldnews/1578146/Iran-envoy-defends-amputation.html |url-access=limited |access-date=2021-06-28}}</ref> [[Saudi Arabia]],<ref name="MC 2007">{{Cite news |date=2007-11-05 |title=Saudi Arabia chops off hand of Egyptian for theft |work=Monsters and Critics |url=http://www.monstersandcritics.com/news/middleeast/news/article_1371270.php/Saudi_Arabia_chops_off_hand_of_Egyptian_for_theft |url-status=dead |access-date=2021-06-27 |archive-url=https://web.archive.org/web/20100811044139/http://www.monstersandcritics.com/news/middleeast/news/article_1371270.php/Saudi_Arabia_chops_off_hand_of_Egyptian_for_theft |archive-date=2010-08-11}}</ref> [[Yemen]],<ref>{{Cite web|date=2013-09-16|title=Yemeni man sentenced to hand and foot amputation for armed robbery|url=https://www.amnesty.org/en/latest/press-release/2013/09/yemeni-man-sentenced-hand-and-foot-amputation-armed-robbery/|access-date=2021-11-03|publisher=Amnesty International|language=en}}</ref> and 11 of the 36 states within [[Nigeria]].<ref>{{Cite news |last=Bamford |first=David |date=2001-07-01 |title=Hand amputation in Nigeria |work=[[BBC News]] |url=http://news.bbc.co.uk/2/hi/africa/1428159.stm |access-date=2021-06-28}}</ref><ref>{{Cite news |last=Bello |first=Ademola |date=2010-06-11 |title=Who Will Save Amputees of Sharia Law in Nigeria? |work=[[Huffington Post]] |url=https://www.huffpost.com/entry/who-will-save-amputees-of_b_532949 |access-date=2021-06-28}}</ref>
* '''[[Cross-amputation]]''' is one of the [[Hudud]] punishments prescribed under [[Fiqh|Islamic jurisprudence]] (Sharia law) and involves cutting off the right hand and left foot of the alleged transgressor.<ref>{{Cite web |last=Tarabella |first=Marc |title=Parliamentary question {{!}} VP/HR - Cross-amputation in Yemen {{!}} E-011050/2013 |publisher=European Parliament |url=https://www.europarl.europa.eu/doceo/document/E-7-2013-011050_EN.html |access-date=2023-08-07 |language=en}}</ref><ref>{{Cite book |last=Peters |first=Rudolph |url=https://books.google.com/books?id=Im95I7FjrvwC |title=Crime and Punishment in Islamic Law: Theory and Practice from the Sixteenth to the Twenty-First Century |date=2005 |publisher=Cambridge University Press |isbn=978-0-521-79226-4 |pages=166 |language=en}}</ref> The scriptural authority for the double amputation procedure is in the [[Quran]] (''surah'' 5.33–34) which stipulates:{{blockquote|The punishment of those who wage war against Allah and His Messenger, and strive with might for mischief through the land is execution or crucifixion, or cutting of hands and feet from opposite sides, or exile from the land. As for the thief, male or female, cut off their hands and feet from opposite ends in recompense for what they have committed.<ref>{{cite web |title=The Quran, sura 5, verse 33 |url=https://www.perseus.tufts.edu/hopper/text?doc=Perseus%3Atext%3A2002.02.0006%3Asura%3D5%3Averse%3D33 |website=Perseus Project|publisher=Tufts University}}</ref>}} The severe [[punishment]], for "highway robbery (''[[hirabah]]'', ''qat' al-tariq'') and civil disturbance against Islam", is usually carried out in a single session in public, without anaesthetic and using a sword. The ancient punishment is practised in Islamic countries such as Saudi Arabia,<ref>{{Cite web |date=2011-12-16 |title=Saudi Arabia: King urged to commute 'cross amputation' sentences |url=https://www.amnesty.org/en/latest/press-release/2011/12/saudi-arabia-king-urged-commute-cross-amputation-sentences/ |access-date=2023-08-07 |publisher=Amnesty International |language=en}}</ref> Sudan,<ref>{{cite web |title=Sudanese man sentenced to cross amputation for committing armed robbery |publisher=African Centre for Justice and Peace Studies |url=https://www.acjps.org/sudanese-man-sentenced-to-cross-amputation-for-committing-armed-robbery/}}</ref> Somalia,<ref>{{cite web |last1=Rice |first1=Xan |title=Somali schoolboy tells of how Islamists cut off his leg and hand |url=https://www.theguardian.com/world/2010/oct/20/somali-islamists-schoolboy-amputation-ordeal |website=The Guardian |date=20 October 2010}}</ref> Mauritania, the Maldives,<ref>{{cite book |url=https://academic.oup.com/book/34967/chapter-abstract/298608517?redirectedFrom=fulltext | title = Crime and Punishment in Islamic Law: A Fresh Interpretation |chapter=32: Shariah Punishments in the Islamic Republics of Mauritania and Maldives, and Islamic State of Yemen|date=2019 |doi=10.1093/oso/9780190910648.003.0032 |last1=Kamali |first1=Mohammad Hashim |pages=321–328 |isbn=978-0-19-091064-8 }}</ref> Iran,<ref>{{cite news |last1=Pannier |first1=Bruce |title=Criminals Lose Hands And Feet As Shari'a Law Imposed |url=https://www.rferl.org/a/1079325.html |website=RadioFreeEurope/RadioLiberty |language=en}}</ref> Afghanistan (under Taliban rule),{{citation needed|date=April 2025}} and Yemen.<ref>{{cite web |author=<!-- Staff--> |title=The World's Most Barbaric Punishments |url=https://www.newsweek.com/worlds-most-barbaric-punishments-74537 |website=Newsweek |language=en |date=8 July 2010}}</ref>
* In 1779, [[Thomas Jefferson]] proposed a bill to the [[Virginia Assembly]] that ostensibly would have replaced [[capital punishment]] with other penalties, including amputation, for certain crimes,<ref name="Boyd TJP">{{cite book |editor-last=Boyd |editor-first=Julian P. |editor-link=Julian P. Boyd |date=1950 |title=[[The Papers of Thomas Jefferson]] |volume=2 |chapter=Bill No. 64. A Bill for Proportioning Crimes and Punishments in Cases Heretofore Capital |pages=492–507 |publisher=[[Princeton University Press]] |chapter-url=https://archive.org/details/thepapersofthoma0002unse/page/492/mode/2up |chapter-url-access=registration}}</ref><ref name="Wilson Bill 64" /> although not all were really punishable by death at the time.<ref>{{harvnb|Boyd|1950|p=505}}</ref> For the crimes of rape, sodomy, and polygamy (the last removed from a later version), the punishment was to be [[castration]] for men or [[rhinotomy]] for women.<ref>{{harvnb|Boyd|1950|pp=497,506n12}}</ref> For [[Mayhem (crime)|intentional maiming]], the bill specified literal [[eye for an eye]] retribution.<ref>{{harvnb|Boyd|1950|p=498}}</ref> The bill never passed, due to the combination of its perceived barbarity in some parts and perceived leniency in others.<ref name="Wilson Bill 64">{{cite encyclopedia |encyclopedia=Thomas Jefferson Encyclopedia |title=Bill 64 |last=Wilson |first=Gaye |date=May 1999 |url=https://www.monticello.org/research-education/thomas-jefferson-encyclopedia/bill-64/ |publisher=Thomas Jefferson Foundation}}</ref><ref>{{harvnb|Boyd|1950|pp=505–506}}</ref>
* In England, the [[Offences within the Court Act 1541]] provided for cutting off a hand as punishment for striking someone inside a courtroom. Thomas Jefferson's punishments revision bill also intended to repeal this.<ref>{{harvnb|Boyd|1950|p=493}}. Jefferson cited a work of [[William Stanford (judge)|Stamford]] and the [[Offences within the Court Act 1541]] (33 Hen 8 c.<!--This stands for "chapter" not "circa". Do not use {{circa}}--> 12).</ref> The punishment was abolished in England and Wales by the [[Offences Against the Person Act 1828]].
* As of 2021, this form of punishment is controversial, as most modern cultures consider it to be morally abhorrent, as it has the effect of permanently disabling a person and constitutes torture. It is thus seen as grossly disproportionate for crimes less than those such as murder.<ref>{{Cite web |url=http://www.amnesty.org.uk/news_details.asp?NewsID=18282 |title=Somalia: Amputation punishments are 'torture' says Amnesty |publisher=Amnesty International |access-date=2021-01-08 |archive-date=2013-10-03 |archive-url=https://web.archive.org/web/20131003223301/https://www.amnesty.org.uk/news_details.asp?NewsID=18282 |url-status=dead }}</ref>

== Surgery ==

===Method===
[[File:Curvy amputation knife DSC09451.jpg|thumb|200px|Curved knives such as this one were used, in the past, for some kinds of amputations.]]
Surgeons performing an amputation have to first [[ligature (medicine)|ligate]] the supplying [[artery]] and [[vein]], so as to prevent [[hemorrhage]] (bleeding). The muscles are transected, and finally, the [[bone]] is sawed through with an [[oscillating saw]]. Sharp and rough edges of bones are filed, skin and muscle flaps are then transposed over the stump, occasionally with the insertion of elements to attach a [[prosthesis]].

[[File:Últimos_momentos_do_heroico_1º_tenente_-_Mariz_e_Barros_-_commandante_do_encouraçado_-_Tamandaré._-.jpg|thumb|left|Amputation of the leg of First Lieutenant [[Antônio Carlos de Mariz e Barros]], commander of the Brazilian [[Brazilian ironclad Tamandaré|Battleship ''Tamandaré'']] (Henrique Fleiuss, ''Semana Illustrada'', [[1866]])]]

Distal stabilisation of muscles is often performed. This allows effective muscle contraction which reduces atrophy, allows functional use of the stump and maintains soft tissue coverage of the remnant bone. The preferred stabilisation technique is myodesis where the muscle is attached to the bone or its periosteum. In joint disarticulation amputations tenodesis may be used where the muscle tendon is attached to the bone. Muscles are attached under similar tension to normal physiological conditions.<ref>{{cite book| vauthors = Smith DG |title=Atlas of Amputations and Limb Deficiencies: Surgical, Prosthetic and Rehabilitation Principles|date=2004|publisher=American Academy of Orthopaedic Surgeons|isbn=978-0892033133|pages=21–30|chapter=Chapter 2. General principles of amputation surgery.}}</ref>

An experimental technique known as the "Ewing amputation" aims to improve post-amputation [[proprioception]].<ref>{{Cite news |last=Springer |first=Shira |date=2018-04-13 |title=How The Marathon Bombing Helped Bring Innovation To Amputation |work=[[WBUR]] |url=https://www.wbur.org/news/2018/04/13/stepping-strong-brigham-amputation |access-date=2021-06-28}}</ref><ref>{{Cite web |date=2016-11-21 |title=Jim Ewing, Dynamic-Model Amputation Patient |url=https://www.brighamandwomensfaulkner.org/about-bwfh/news/ewing |access-date=2021-06-28 |website=Brigham and Women's Faulkner Hospital}}</ref> Another technique with similar goals, which has been tested in a clinical trial,<ref>[https://news.mit.edu/2021/surgery-control-prosthetic-limbs-0215 New surgery may enable better control of prosthetic limbs]</ref> is Agonist-antagonist Myoneural Interface (AMI).<ref>[https://www.media.mit.edu/projects/agonist-antagonist-myoneural-interface-ami/overview/ Agonist-antagonist Myoneural Interface (AMI)]</ref>

In 1920,&nbsp; Dr. Janos Ertl Sr. of [[Hungary]], developed the Ertl procedure in order to return a high number of amputees to the workforce.<ref>{{cite web|url=http://www.ertlreconstruction.com/|archive-url=https://web.archive.org/web/20040201185051/http://www.ertlreconstruction.com/|url-status=usurped|archive-date=February 1, 2004|title=Ertl Reconstruction - amputation|website=www.ertlreconstruction.com|access-date=2018-11-24}}</ref>  The Ertl technique, an osteomyoplastic procedure for transtibial amputation, can be used to create a highly functional residual limb. Creation of a tibiofibular bone bridge provides a stable, broad tibiofibular articulation that may be capable of some distal weight bearing. Several different modified techniques and fibular bridge fixation methods have been used; however, no current evidence exists regarding comparison of the different techniques.<ref>{{Cite journal |vauthors=Fischgrund JS |date=June 2016 |title=JAAOS Research |journal=The Journal of the American Academy of Orthopaedic Surgeons |volume=24 |issue=6 |page=392 |doi=10.5435/jaaos-d-16-00309 |pmid=27213622 }}</ref>

=== Post-operative management ===
A 2019 [[Cochrane (organisation)|Cochrane]] [[systematic review]] aimed to determine whether rigid dressings were more effective than soft dressings in helping wounds heal following transtibial (below the knee) amputations. Due to the limited and very low certainty of evidence available, the authors concluded that it was uncertain what the benefits and harms were for each dressing type. They recommended that clinicians consider the pros and cons of each dressing type on a case-by-case basis: rigid dressings may potentially benefit patients who have a high risk of falls; soft dressings may potentially benefit patients who have poor skin integrity.<ref>{{cite journal | vauthors = Kwah LK, Webb MT, Goh L, Harvey LA | title = Rigid dressings versus soft dressings for transtibial amputations | journal = The Cochrane Database of Systematic Reviews | volume = 2019 | pages = CD012427 | date = June 2019 | issue = 6 | pmid = 31204792 | pmc = 6573094 | doi = 10.1002/14651858.cd012427.pub2 }}</ref>

A 2017 review found that the use of rigid removable dressings (RRD's) in trans-tibial amputations, rather than soft bandaging, improved healing time, reduced edema, prevented knee flexion contractures and reduced complications, including further amputation, from external trauma such as falls onto the stump.<ref>{{cite journal | vauthors = Reichmann JP, Stevens PM, Rheinstein J, Kreulen CD | title = Removable Rigid Dressings for Postoperative Management of Transtibial Amputations: A Review of Published Evidence | journal = PM&R | volume = 10 | issue = 5 | pages = 516–523 | date = May 2018 | pmid = 29054690 | doi = 10.1016/j.pmrj.2017.10.002 | s2cid = 21732925 }}</ref>

Post-operative management, in addition to wound healing, considers maintenance of limb strength, joint range, edema management, preservation of the intact limb (if applicable) and stump desensitization.

== Trauma ==
Traumatic amputation is the partial or total avulsion of a part of a body during a serious accident, like traffic, labor, or combat.<ref>{{Cite book |url=https://accessmedicine.mhmedical.com/book.aspx?bookid=675 |title=Current Diagnosis & Treatment in Orthopedics |vauthors=Smith DG, Skinner HB |date=2014 |publisher=McGraw-Hill Education. |isbn=978-0-07-159075-4 |veditors=Skinner HB, McMahon PJ |edition=5th |chapter=Amputations |chapter-url=https://accessmedicine.mhmedical.com/content.aspx?bookid=675&sectionid=45451717}}</ref><ref name="Watson1986">{{Cite book |title=Hand Injuries and Infections |vauthors=Watson N |publisher=Gower Medical |year=1986 |isbn=0906923808 |location=London}}</ref>

Traumatic amputation of a human limb, either partial or total, creates the immediate danger of death from blood loss.<ref>{{Cite journal |vauthors=Ramirez C, Menaker J |date=2017-05-01 |title=Traumatic Amputations |url=https://www.reliasmedia.com/articles/140552-traumatic-amputations |journal=Trauma Reports |volume=18 |issue=3}}</ref>

Orthopedic surgeons often assess the severity of different injuries using the Mangled Extremity Severity Score. Given different clinical and situational factors, they can predict the likelihood of amputation. This is especially useful for emergency physicians to quickly evaluate patients and decide on consultations.<ref>{{cite journal | vauthors = Johansen K, Daines M, Howey T, Helfet D, Hansen ST | title = Objective criteria accurately predict amputation following lower extremity trauma | journal = The Journal of Trauma | volume = 30 | issue = 5 | pages = 568–72; discussion 572–3 | date = May 1990 | pmid = 2342140 | doi = 10.1097/00005373-199005000-00007 | doi-access = free }}</ref>

===Causes===
[[File:3372709503 10dc75d783 oSéquelleAmputation.jpg|thumb|170px|Private Lewis Francis was wounded July 21, 1861, at the [[First Battle of Bull Run]] by a bayonet to the knee.]]
Traumatic amputation is uncommon in humans (1 per 20,804 population per year). Loss of limb usually happens immediately during the accident, but sometimes a few days later after medical complications. Statistically, the most common causes of traumatic amputations are:<ref>{{Cite web |date=2017-10-17 |title=Amputation |url=https://www.nhs.uk/conditions/amputation/ |access-date=2022-09-07 |website=nhs.uk |language=en}}</ref>
* Vehicle accidents (cars, motorcycles, bicycles, trains, etc.)
* Labor accidents (equipment, instruments, cylinders, chainsaws, press machines, meat machines, wood machines, etc.)
* Agricultural accidents, with machines and mower equipment
* Electric shock hazards
* Firearms, bladed weapons, explosives
* Violent rupture of ship rope or industry wire rope
* Ring traction (ring amputation, de-gloving injuries)
* Building doors and car doors
* Animal attacks
* Gas cylinder explosions<ref>{{Cite magazine |date=February 2011 |editor-last=Davison |editor-first=Ben |title=Scuba Tanks as Lethal Weapons |url=https://www.undercurrent.org/UCnow/dive_magazine/2011/LethalWeapons201102.html |url-status=live |magazine=Undercurrent |publication-place=Sausalito, California |volume=26 |issue=2 |pages=8–9 |archive-url=https://web.archive.org/web/20210428060005/https://www.undercurrent.org/UCnow/dive_magazine/2011/LethalWeapons201102.html |archive-date=2021-04-28 |access-date=28 June 2021}}</ref>
* Other rare accidents<ref>{{Cite journal |last1=Clasper |first1=Jon |last2=Ramasamy |first2=Arul |date=2013 |title=Traumatic amputations |journal=British Journal of Pain |volume=7 |issue=2 |pages=67–73 |doi=10.1177/2049463713487324 |issn=2049-4637 |pmc=4590129 |pmid=26516502}}</ref>

===Treatment===
The development of the science of [[microsurgery]] over the last 40 years has provided several treatment options for a traumatic amputation, depending on the patient's specific trauma and clinical situation:<ref>{{Cite journal |last1=Yoo |first1=Hyokyung |last2=Kim |first2=Byung Jun |date=2021-07-27 |title=History and Recent Advances in Microsurgery |url=https://synapse.koreamed.org/articles/1147742 |journal=Archives of Hand and Microsurgery |volume=26 |issue=3 |pages=174–183 |doi=10.12790/ahm.21.0097|doi-access=free }}</ref>
* 1st choice: Surgical amputation - break - prosthesis
* 2nd choice: Surgical amputation - transplantation of other tissue - plastic reconstruction.
* 3rd choice: [[Replantation]] - reconnection - revascularisation of amputated limb, by microscope (after 1969)
* 4th choice: Transplantation of cadaveric hand (after 2000)<ref name="Watson1986" />

===Epidemiology===
[[File:In Khmelnytskyi, the President Paid a Visit to the Warriors Recovering from Wounds and Presented Them with Awards. (53698029200).jpg|thumb|Up to 50,000 Ukrainians lost their limbs during the [[Russian invasion of Ukraine]].<ref>{{cite news |title='A new life': Ukrainian war amputees travel to Germany for custom-made limbs |url=https://edition.cnn.com/2024/06/03/europe/ukraine-soldiers-germany-prosthetic-limbs-intl-cmd/index.html |work=CNN |date=3 June 2024}}</ref>]]
* In the United States in 1999, there were 14,420 non-fatal traumatic amputations according to the [[American Statistical Association]]. Of these, 4,435 occurred as a result of traffic and transportation accidents and 9,985 were due to labor accidents. Of all traumatic amputations, the distribution percentage is 30.75% for traffic accidents and 69.24% for labor accidents.<ref name="amstat.org">{{Cite web|url=https://www.amstat.org//|title=American Statistical Association (ASA)|website=www.amstat.org}}</ref>{{Nonspecific|date=June 2021}}
* The population of the United States in 1999 was about 300,000,000, so the conclusion is that there is one amputation per 20,804 persons per year. In the group of labor amputations, 53% occurred in laborers and technicians, 30% in production and service workers, 16% in silviculture and fishery workers.<ref name="amstat.org"/>{{Nonspecific|date=June 2021}}
* A study found that in 2010, 22.8% of patients undergoing amputation of a lower extremity in the United States were readmitted to the hospital within 30 days.<ref>{{Cite journal |vauthors=Weiss AJ, Elixhauser A, Steiner C |date=April 2013 |title=Readmissions to U.S. Hospitals by Procedure, 2010 |url=https://hcup-us.ahrq.gov/reports/statbriefs/sb154.jsp |journal=HCUP Statistical Brief |issue=154 |publisher=[[U.S. Agency for Healthcare Research and Quality]] |pmid=24006552 |publication-place=Rockville, Maryland}}</ref>
* In 2017, an estimated 57.7 million people globally were living with existing traumatic limb injuries. Of these 57.7 million, the leading causes of amputation "were falls (36.2%), road injuries (15.7%), other transportation injuries (11.2%), and mechanical forces (10.4%)."<ref>{{Cite journal |last1=McDonald |first1=Cody L. |last2=Westcott-McCoy |first2=Sarah |last3=Weaver |first3=Marcia R. |last4=Haagsma |first4=Juanita |last5=Kartin |first5=Deborah |date=2021-04-01 |title=Global prevalence of traumatic non-fatal limb amputation |url=https://pubmed.ncbi.nlm.nih.gov/33274665/ |journal=Prosthetics and Orthotics International |volume=45 |issue=2 |pages=105–114 |doi=10.1177/0309364620972258 |issn=1746-1553 |pmid=33274665}}</ref>
* On 2 August 2023, an investigation by ''[[The Wall Street Journal]]'' found that Ukrainian medical amputations in the war came to between 20,000 and 50,000 including both military and civilians. In comparison, during [[World War One]] 41,000 British and 67,000 Germans needed amputations.<ref>{{cite web |url=https://www.businessinsider.com/amputations-ukraine-levels-not-seen-since-world-war-i-report-2023-8 |title=Amputations in Ukraine are as widespread as in the trenches of World War I due to Russia's heavy use of mines and artillery: report |date=2 August 2023 |last=Porter |first=Tom |work=[[Business Insider]]}}</ref>
* In 2024 [[Gaza Strip|Gaza]] was the site of the most child amputees in the history.<ref>[https://www.aljazeera.com/program/the-stream/2024/7/2/the-amputee-crisis-in-the-war-on-gaza The amputee crisis in the war on Gaza], 2 Jul 2024</ref>

==Prevention==
Methods in preventing amputation, [[limb-sparing techniques]], depend on the problems that might cause amputations to be necessary. Chronic infections, often caused by diabetes or [[decubitus ulcers]] in bedridden patients, are common causes of infections that lead to gangrene, which, when widespread, necessitates amputation.<ref>{{Cite web |date=2019-11-19 |title=Gangrene |url=https://www.hopkinsmedicine.org/health/conditions-and-diseases/gangrene |access-date=2023-10-31 |website=www.hopkinsmedicine.org |language=en}}</ref>

There are two key challenges: first, many patients have impaired circulation in their extremities, and second, they have difficulty curing infections in limbs with poor blood circulation.<ref>{{Cite web |last=CDC |date=2023-04-07 |title=Preventing Diabetes-Related Amputations (Part 1) |url=https://www.cdc.gov/diabetes/library/features/amputations.html |access-date=2023-10-31 |website=Centers for Disease Control and Prevention |language=en-us}}</ref><ref>{{Cite web |title=Avoiding Amputations |url=https://www.templehealth.org/services/heart-vascular/patient-care/patient-support/understanding-heart-vascular-disease/avoiding-amputations |access-date=2023-10-31 |website=Temple Health |language=en}}</ref>

Crush injuries where there is extensive tissue damage and poor circulation also benefit from [[Hyperbaric medicine|hyperbaric oxygen therapy]] (HBOT). The high level of oxygenation and revascularization speed up recovery times and prevent infections.<ref>{{Cite web |title=Hyperbaric oxygen therapy - Mayo Clinic |url=https://www.mayoclinic.org/tests-procedures/hyperbaric-oxygen-therapy/about/pac-20394380 |access-date=2023-10-31 |website=www.mayoclinic.org |language=en}}</ref>

A study found that the patented method called Circulator Boot achieved significant results in prevention of amputation in patients with diabetes and arteriosclerosis.<ref name=dillon1>{{cite journal | vauthors = Bouskela E, Donyo KA | title = Effects of oral administration of purified micronized flavonoid fraction on increased microvascular permeability induced by various agents and on ischemia/reperfusion in the hamster cheek pouch | journal = Angiology | volume = 48 | issue = 5 | pages = 391–9 | date = May 1997 | pmid = 9158383 | doi = 10.1177/000331979704800503 | s2cid = 28978927 | url = http://www.circulatorboot.com/literature/angiology1.html | archive-url = https://web.archive.org/web/20101125035502/http://circulatorboot.com/literature/angiology1.html | url-status = dead | archive-date = 2010-11-25 | access-date = 2010-06-24 | url-access = subscription }}</ref><ref name=dillon2>{{cite journal | vauthors = Dillon RS | title = Patient assessment and examples of a method of treatment. Use of the circulator boot in peripheral vascular disease | journal = Angiology | volume = 48 | issue = 5 Pt 2 | pages = S35–58 | date = May 1997 | pmid = 9158380 | doi = 10.1177/000331979704800504 | s2cid = 23512929 | url = http://www.circulatorboot.com/literature/angiology1.html | archive-url = https://web.archive.org/web/20101125035502/http://circulatorboot.com/literature/angiology1.html | url-status = dead | archive-date = 2010-11-25 | access-date = 2010-06-24 | url-access = subscription }}</ref> Another study found it also effective for healing limb ulcers caused by peripheral vascular disease.<ref name=vella>{{cite journal | vauthors = Vella A, Carlson LA, Blier B, Felty C, Kuiper JD, Rooke TW | title = Circulator boot therapy alters the natural history of ischemic limb ulceration | journal = Vascular Medicine | volume = 5 | issue = 1 | pages = 21–5 | year = 2000 | pmid = 10737152 | doi = 10.1177/1358836X0000500104 }}</ref> The boot checks the heart rhythm and compresses the limb between heartbeats; the compression helps cure the wounds in the walls of veins and arteries, and helps to push the blood back to the heart.<ref>{{Cite AV media |url=https://newsnetwork.mayoclinic.org/discussion/circulator-boot/ |title=Circulator Boot |date=2008-07-11 |last=Williams |first=Vivien |type=video |publisher=[[Mayo Clinic|Mayo Clinic News Network]] |time=1:08–1:32 |access-date=2021-06-27}}</ref>

For victims of trauma, advances in [[microsurgery]] in the 1970s have made replantation of severed body parts possible.

The establishment of laws, rules, and guidelines, and the employment of modern equipment help protect people from traumatic amputations.<ref>{{Cite journal |last1=Roon |first1=Anthony J. |last2=Moore |first2=Wesley S. |last3=Goldstone |first3=Jerry |date=1977 |title=Below-knee amputation: A modern approach |journal=The American Journal of Surgery |volume=134 |issue=1 |pages=153–158 |doi=10.1016/0002-9610(77)90299-9 |pmid=879408 |issn=0002-9610}}</ref>

==Prognosis==
The individual may experience psychological trauma and emotional discomfort. The stump will remain an area of reduced mechanical stability. Limb loss can present significant or even drastic practical limitations.<ref name="Amputation">{{Cite web |date=2023-03-15 |title=Amputation |url=https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/amputation |access-date=2023-10-31 |website=www.hopkinsmedicine.org |language=en}}</ref>

A large proportion of amputees (from 50 to 80% to 80-100%, according to different studies) experience the phenomenon of [[phantom limb]]s;<ref>{{cite journal|date=January 2005 |title=The Science of Things | first = Heidi | last = Schultz | name-list-style = vanc |journal=National Geographic Magazine |url=http://magma.nationalgeographic.com/ngm/0501/resources_who.html |url-status=dead |archive-url=https://web.archive.org/web/20080906143209/http://magma.nationalgeographic.com/ngm/0501/resources_who.html |archive-date=September 6, 2008 }}</ref><ref name="PhantomReview2007">{{cite journal |last1=Chahine |first1=Lama |last2=Kanazi |first2=Ghassan |date=2007 |title= Phantom limb syndrome: A review |url=https://pdfs.semanticscholar.org/0f8d/2b80b5c20ed0e21076de4b5ac48327ca05d2.pdf |archive-url=https://web.archive.org/web/20190721010514/https://pdfs.semanticscholar.org/0f8d/2b80b5c20ed0e21076de4b5ac48327ca05d2.pdf |url-status=dead |archive-date=2019-07-21 |journal= MEJ Anesth|volume=19 |issue= 2|pages=345–55 |s2cid=16240786 |access-date=July 20, 2019 }}</ref> they feel body parts that are no longer there. These limbs can itch, ache, burn, feel tense, dry or wet, locked in or trapped or they can 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]]).

A similar phenomenon is an unexplained sensation in a body part unrelated to the amputated limb. It has been hypothesized that the portion of the brain responsible for processing stimulation from amputated limbs, being deprived of input, expands into the surrounding brain, (''[[Phantoms in the Brain]]'': [[V.S. Ramachandran]] and [[Sandra Blakeslee]]) such that an individual who has had an arm amputated will experience unexplained pressure or movement on his face or head.<ref>{{Cite journal |last1=MacIver |first1=K. |last2=Lloyd |first2=D. M. |last3=Kelly |first3=S. |last4=Roberts |first4=N. |last5=Nurmikko |first5=T. |date=August 2008 |title=Phantom limb pain, cortical reorganization and the therapeutic effect of mental imagery |journal=Brain |volume=131 |issue=8 |pages=2181–2191 |doi=10.1093/brain/awn124 |issn=0006-8950 |pmid=18567624|pmc=2494616 }}</ref>

In many cases, the phantom limb aids in adaptation to a prosthesis, as it permits the person to experience [[proprioception]] of the prosthetic limb. To support improved resistance or usability, comfort or healing, some types of [[stump sock]]s may be worn instead of or as part of wearing a prosthesis.<ref name="Amputation"/>

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 [[improvised explosive device]]s in the [[Iraq War]].<ref>{{cite news |url=http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2006/03/26/MNSOLDIERS26.DTL |title=War without end / Damaged soldiers start their agonizing recoveries |first=Joan |last=Ryan |name-list-style=vanc |date=March 25, 2006 |work=The San Francisco Chronicle |archive-url=https://web.archive.org/web/20110208093622/http://www.sfgate.com/cgi-bin/article.cgi?f=%2Fc%2Fa%2F2006%2F03%2F26%2FMNSOLDIERS26.DTL |archive-date=February 8, 2011 |url-status=live |access-date=June 4, 2017 }}</ref>

Due to technological advances in prosthetics, many amputees live active lives with little restriction. Organizations such as the [[Challenged Athletes Foundation]] have been developed to give amputees the opportunity to be involved in athletics and [[adaptive sports]] such as [[Amputee football|amputee soccer]].<ref>{{Cite web |last=Hoock |first=Maja |date=September 2021 |title=Innovative prostheses positively change the Paralympics |url=https://www.wipo.int/wipo_magazine/en/2021/03/article_0007.html |access-date=October 30, 2023 |website=WIPO}}</ref>

Nearly half of the individuals who have an amputation due to vascular disease will die within 5 years, usually secondary to the extensive co-morbidities rather than due to direct consequences of an amputation. This is higher than the five year mortality rates for breast cancer, colon cancer, and prostate cancer.<ref>{{cite journal | vauthors = Robbins JM, Strauss G, Aron D, Long J, Kuba J, Kaplan Y | s2cid = 38232703 | title = Mortality rates and diabetic foot ulcers: is it time to communicate mortality risk to patients with diabetic foot ulceration? | journal = Journal of the American Podiatric Medical Association | volume = 98 | issue = 6 | pages = 489–93 | date = November 2008 | pmid = 19017860 | doi = 10.7547/0980489 }}</ref>  Of persons with diabetes who have a lower extremity amputation, up to 55% will require amputation of the second leg within two to three years.<ref>{{cite book| vauthors = Savage PE |chapter=The diabetic foot|date=1983|pages=69–73|publisher=Springer Netherlands|isbn=9789401166508|doi=10.1007/978-94-011-6648-5_12|title=Problems in Peripheral Vascular Disease}}</ref>

==Etymology==
The word amputation is borrowed from Latin ''amputātus,'' past participle of ''amputāre'' "to prune back (a plant), prune away, remove by cutting (unwanted parts or features), cut off (a branch, limb, body part)," from ''am-,'' assimilated variant of ''amb-'' "about, around" + ''putāre'' "to prune, make clean or tidy, scour (wool)". The English word "Poes" 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.<ref>{{Cite book |last=Lowe |first=Peter |url=http://archive.org/details/b30327994_0003 |title=A discourse of the whole art of chyrurgerie. Wherein is exactly set downe the definition, causes, accidents, prognostications, and cures of all sorts of diseases ... Wherunto is added the rule of making remedies which chirurgions doe commonly use: with the Presages of divine Hyppocrates |date=1612 |publisher=London : Thomas Purfoot |others=Wellcome Library}}</ref>

==Notable cases==
===Without prosthesis===
* [[Rick Allen (drummer)|Rick Allen]]
* [[Bethany Hamilton]]
* [[Nick Vujicic]]

===With prosthesis===
* [[Götz von Berlichingen|Götz of the Iron Hand]]
* [[Jessica Long]]
* [[Sarah Reinertsen]]

===Other===
* [[Patch Adams]]
* [[Douglas Bader]]
* [[Carl Brashear]]
* [[Lisa Bufano]]
* [[Roberto Carlos (singer)|Roberto Carlos]]
* [[Tammy Duckworth]]
* [[Kalamandalam Sankaran Embranthiri]]
* [[Terry Fox]]
* [[Zach Gowen]] 
* [[Pete Gray]]
* [[Shaquem Griffin]]
* [[Robert David Hall]]
* [[Hugh Herr]]
* [[Frida Kahlo]]
* [[Ronnie Lott]]
* [[Hari Budha Magar]]
* [[Aimee Mullins]]
* [[Oscar Pistorius]]
* [[Amy Purdy]]
* [[Aron Ralston]]
* [[Hans-Ulrich Rudel]]
* [[Luiz Inácio Lula da Silva]]
* [[Alex Zanardi]]

== See also ==
{{columns-list|colwidth=25em|
* [[Acrotomophilia]]
* [[Adapted automobile]]
* [[Flail limb]]
* [[Robotic prosthesis control]]

}}

== References ==
{{reflist|colwidth=30em}}

== Further reading ==
* Bilguer, Johann Ulrich, (1764), ''[https://www.gutenberg.org/ebooks/44089 A dissertation on the inutility of the amputation of limbs]''.
* Miller, Brian Craig. ''Empty Sleeves: Amputation in the Civil War South'' (University of Georgia Press, 2015). xviii, 257 pp.

{{Medical resources
|  DiseasesDB     =
|  ICD11   = ''Medical'': {{ICD11|PK80.80}}; ''Traumatic'': {{ICD11|NA09}}, {{ICD11|NA63}}, {{ICD11|NB33}}, {{ICD11|NC18}}, {{ICD11|NC38}}, {{ICD11|NC59}}, {{ICD11|NC78}}, {{ICD11|NC98}}, {{ICD11|ND19}}, {{ICD11|ND35}}
|  ICD10   = ''Medical'': {{ICD10|Y83.5}}; ''Traumatic'': S*8 (e.g. {{ICD10|S68}}), {{ICD10|T05}}, {{ICD10|T09.6}}, {{ICD10|T11.6}}, {{ICD10|T13.6}}, {{ICD10|T14.7}}
|  ICD9           =
|  ICDO           =
|  OMIM           =
|  MedlinePlus    =
|  eMedicineSubj  =
|  eMedicineTopic =
|  MeshID         = D000673
}}

{{Muscle/soft tissue procedures}}
{{Substantive human rights}}

{{Authority control}}

[[Category:Amputation| ]]
[[Category:Surgical removal procedures]]
[[Category:Acute pain]]
[[Category:Punishments]]
[[Category:Surgery]]