Separation of the most proximal part of the leg from the rest of the torso. The thigh is the portion of the leg between the hip and the knee.
The cause is usually traumatic although it may be secondary to elective surgery.
When amputation is performed in the context of surgery, blood vessels are tied off to prevent bleeding before bone and muscle are cut. The most frequent causes are diseases causing poor blood circulation, tumours, deformities, infections and/or gangrene.
When amputation occurs in the context of trauma, bleeding and tissue loss are usually greater. When the limb is torn off or avulsed, bleeding can be massive and surgical repair very difficult. The most common causes are traffic accidents, industrial accidents and war injuries.
The treatment of choice is surgical and the priority is to save as much of the limb as possible and to avoid bleeding and infection. Severe cases can lead to death of the patient if not controlled.
In cases of traumatic amputation, a tourniquet may be used to stop bleeding until surgical revision is performed. If the amputated limb and residual limb are properly cared for, reattachment of the amputated limb in a specialised centre may be considered.
- Jeremy W Cannon, MD, FACS; Todd E Rasmussen, MD, FACS, COL, USAF, MC. Severe extremity injury in the adult patient. UpToDate.
- Johansen K, Daines M, Howey T, et al. Objective criteria accurately predict amputation following lower extremity trauma. J Trauma 1990; 30:568.
- de Mestral C, Sharma S, Haas B, et al. A contemporary analysis of the management of the mangled lower extremity. J Trauma Acute Care Surg 2013; 74:597.
- Perkins ZB, Yet B, Glasgow S, et al. Meta-analysis of prognostic factors for amputation following surgical repair of lower extremity vascular trauma. Br J Surg 2015; 102:436.
- Fox CJ, Gillespie DL, O'Donnell SD, et al. Contemporary management of wartime vascular trauma. J Vasc Surg 2005; 41:638.
- Meling T, Harboe K, Søreide K. Incidence of traumatic long-bone fractures requiring in-hospital management: a prospective age- and gender-specific analysis of 4890 fractures. Injury 2009; 40:1212.
- Dorlac WC, DeBakey ME, Holcomb JB, et al. Mortality from isolated civilian penetrating extremity injury. J Trauma 2005; 59:217.
- Swan KG Jr, Wright DS, Barbagiovanni SS, et al. Tourniquets revisited. J Trauma 2009; 66:672.
