Amputation notes

Well cometh the hour, cometh the man as they say, whenever 'they' are feeling particularly pompous. My last day at work came and went with no dramas except a power cut that activated the evacuation alarm and brought the fire service to the party which translates into more paperwork for me.

I've been cobbling together my various notes over the past week or so and now that I'm finally up to date with everything I thought that a few pages on amputation might be of use to some of the budding Sweeny Todds out there in the big wide world that is LondonTown.

The joke, of course, being that Sweeny Todd isn't ever going to stitch anyone up since it all goes into Mrs Lovetts pies

Since this affects two of my main characters, Evelyn is missing a hand and is the one to chop off the leg of  Straggletaggle the dog as it is too far gone for her to save it, I wanted to get the procedure right which led to more research (yay) of various web sites and, much to the concern of the local librarians, several medical journals of varying reputation and quality.

AMPUTATION LINKS

• http://en.wikipedia.org/wiki/Flap_(surgery)
• http://www.strangecosmos.com/content/item/162566.html - Amputation knife
• http://www.braceface.com/medical/Civil_War_Articles/Civil_War_amputation_procedures.htm – very useful
• http://www.reversegangrene.com/foot_gangrene_amputation_pictures.htm - Bit of an adsite but useful information none the less.
• http://www.worldwidewounds.com/2006/september/Harker/Wound-Healing-Complications-Limb-Amputation.html
• http://www.vascular.co.nz/Amputation%20surgery.htm
• http://www.horseadvice.com/horse/messages/4/53813.html
• http://en.wikipedia.org/wiki/Maggot_therapy  - More for dealing with infection.  Too slow to be of use in the actual amputation.
• http://www.petplace.com/dogs/limb-amputation-in-dogs/page1.aspx - exceedingly useful

AMPUTATION NOTES:

PROCESS

1. Make an incision in the skin and peel back.
2. Scalpel to cut through muscles and tendons, further up the leg.
3. Peel back the flesh then capital bone saw which severs that leg
4. tenaculum grabs hold of artieres and blood vessels. Silk thread or horse hair used to tie them off.
5. Smooth out the end of the bone with clippers and a file, gnawing forceps
6. Left with a flap of muscle and skin that hangs down below the bone. These are sewn together to make a cushion that forms the stump.

PHYSICAL IMPACT:

1. After amputation of a foot or leg, the body weight of an amputee shifts to the other leg. The resulting wear and tear often leads to problems in the other foot or leg, and in a few years similar problems may develop, necessitating another amputation. If this degenerative process continues, the results may be fatal.
2. After an amputation, the muscles in and around the residual limb shorten. This pulls your joint into a bent position. If it is left like this for long periods of time, it will become difficult to straighten, or even become permanently stuck. Hence daily exercise is a necessity

PSYCHOLOGICAL IMPACT:

1. Losing a limb has also a negative psychological impact. It leaves amputees feeling depressed, angry, or alone. They feel that they're no longer whole persons; or fear that others stare at them, or avoid them.
2. Loss of limb can be compared to losing a spouse or a child. The first time you see your body after the surgery will be very disturbing. You may be shocked to look down and see that a part of your body is missing. The trauma is deep and multi-layered. So it is not easy to adjust to the loss.

PAIN AND RECOVERY:

1. You will have very strong pain after your amputation surgery because the surgeon has cut through skin, muscles, nerves and bone. Your limb will be swollen. Swelling can cause pain and limit movement.
2. Recovery is never a fast process. Each step is difficult: sitting up in bed, then sitting in a wheelchair, standing, then using crutches.
3. Types of pains:Besides stress, tension, and anxiety, amputees experience pains due to the loss of limb. Here are the most common types of pain:

1. Immediate post-op limb pain:where skin, nerves, bones, and muscle have been cut; it is exeperienced by everyone after an amputation.
2. Residual limb pain:Located in the natural limb (stump) after the amputation and may be present long after the surgery as the residual limb is usually more sensitive than other parts of the body. Unfortunately, there is no one method or treatment guaranteed to reduce or eliminate residual limb pain. Sometimes more surgery is necessary. Sometimes nothing will help.
3. Phantom sensation or feeling: I the amputated "phantom" limb which has been removed, such as itching, tingling, warmth, cold, pain, cramping, constriction, movement and any other imaginable sensation; it is experienced by almost all amputees.
   
   The brain is “remembering” the missing part of the limb, and is still “reporting” its feelings.
4. Phantom painIin the missing or amputated part of the limb; it varies from person to person - a little annoying, very unpleasant, severe, or disabling; it is different from pain in the residual limb and experienced by about 60–80 percent of amputees.
   
   Unfortunately, there is not one single guaranteed treatment to reduce or eliminate phantom pain. In most cases, it disappears within months, though most amputees (as many as 40 percent of them) may still experience phantom pain from time to time.
   
1. Management of post-amputation pain is a major problem and usually requires professional help; however, our understanding of the way at the brain handles pain and other sensations is still fairly crude.