Traumatic amputation is the partial or total avulsion of a part of human body, during a serious accident, like traffic, labor, etc,,.

Traumatic amputation of a human limb, either partial or total, is a tragedy for the victim. Besides the immediate danger of death due to blood loss, the victim also experiences various difficulties from losing a limb.

Below are some advances in techniques from the past 40 years.

• Decrease of deaths from amputations, because of Quickly First Aid and Tourniquet and Injured person transport by Ambulance or Helicopter or Aeroplane.
• Discovery of Microsurgery and Reconstructive Surgery from 70' decade, viz Replantation (=reconnection) of amputated Limbs.
• Availability of high Technology of prostheses for amputated hands and legs, today Robotic pattern.
• Technological and Social changes, established, to protect people from Traumatic Amputations, and we have already a gradual decrease of amputation statistics.

Classification

• Medical amputation
  Amputation
  Amputation is the removal of a body extremity by trauma, prolonged constriction, 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...
  
   after a diabetes infection, or after a diabetes ischaemic gangraine, or after malignant tumors, etc.
• Criminal amputation during civil wars (like in Sierra Leone) or in war or in criminal fact.
• Social amputation: There are some "strange" amputations in some nonaligned countries of the planet, where we see official amputations for criminal punishment (par example for steal), especially in some Islamic countries. Castration
  Castration
  Castration is any action, surgical, chemical, or otherwise, by which a male loses the functions of the testicles or a female loses the functions of the ovaries.-Humans:...
  
   was a terrible historical habit, in the harems of Chinese Emperors, and also in harems of Ottoman Sultan
  Sultan
  Sultan is a title with several historical meanings. Originally, it was an Arabic language abstract noun meaning "strength", "authority", "rulership", and "dictatorship", derived from the masdar سلطة , meaning "authority" or "power". Later, it came to be used as the title of certain rulers who...
  
  s, in target to protect the women of harem
  Harem
  Harem refers to the sphere of women in what is usually a polygynous household and their enclosed quarters which are forbidden to men...
  
   from intercourse with the men of harem. Today, a type of social amputation is Clitoridectomy
  Clitoridectomy
  Clitoridectomy is the surgical removal of the clitoris. It is rarely needed as a therapeutic medical procedure, such as when cancer has developed in or spread to the clitoris...
  
   (removal of Clitoris) in some African Islamic Countries, and also the widely acceptable Circumcision
  Circumcision
  Male circumcision is the surgical removal of some or all of the foreskin from the penis. The word "circumcision" comes from Latin and ....
  
   in Jewish populations,.

Cause

Traumatic Amputation in man is rare (1: 20.804 persons per year). Loss of limb usually happens immediately during the accident, but some times a few days later after medical complications. Statistically the most common causes of traumatic amputations are :

• Amputations in Traffic accidents (cars, moto, bicycles, trains, etc)
• Amputations in Labor accidents (equipments, instruments, cylinders, chain saws, press machines, meat machines, wood machines, etc)
• Amputations in Agricultural accidents, with machines and mower equipments.
• Amputations from Electric Shock hazard
• Amputations from Guns, weapons, and explosives, dynamite, bombs, fireworks, terrorism attacks, etc.
• Amputations from Violent rupture of ship rope or industry wire rope.
• Amputations from Ring Traction (Ring amputation, de-gloving injuries)
• Amputations from Building Doors and Car Doors.
• Amputations from other rare accidents.

Treatment

On the base of last evolution of the science of Microsurgery

Microsurgery

Microsurgery is a general term for surgery requiring an operating microscope. The most obvious developments have been procedures developed to allow anastomosis of successively smaller blood vessels and nerves which have allowed transfer of tissue from one part of the body to another and...

 in last 40 years, a Traumatic amputation can be confronted with these choices, depending from patient's trauma and clinical situation:

• 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 year 1969)
• 4th choice: Transplantation of cadaveric hand (after year 2000),

Epidemiology

• In United States of America, in year 1999 detailed 14.420 non fatal Traumatic amputations according to American Statistical Association
  American Statistical Association
  The American Statistical Association , is the main professional US organization for statisticians and related professions. It was founded in Boston, Massachusetts on November 27, 1839, and is the second oldest, continuously operating professional society in the United States...
  
  . From them the 4.435 became from traffic and transportation accidents, and the 9.985 became from labor accidents. So inside all amputations, the distribution percentage is 30,75% for traffic accidents, and 69,24% for labor accidents.
• The population of USA in 1999 was about 300.000.000, so, the conclusion is that there is one amputation per year per 20.804 persons. In the group of labor amputations we had 53% labors and technicians, 30% in production and service, 16% in silviculture and fishery.
• Statistics in other countries are different. Unfortunately the European Eurostat
  Eurostat
  Eurostat is a Directorate-General of the European Commission located in Luxembourg. Its main responsibilities are to provide the European Union with statistical information at European level and to promote the integration of statistical methods across the Member States of the European Union,...
  
  does not give statistics about traumatic amputations in his website https://ec.europa.eu/eurostat.

Indications - Contraindications

• Replantation is generally indicated in the following amputations:

• 1. Multiple digits
• 2. Thumb
• 3. Hand amputations through the palm or carpus
• 4. Wrist or forearm
• 5. At or proximal to the elbow when there is a clean-cut guillotine-like amputation
• 6. Individual digits distal to the insertion of the flexor digitorum superficialis on the middle phalanx
• 7. Amputations in a child

• Relative contraindications to replantation are:

• 1. Amputations at multiple levels
• 2. Mangled parts
• 3. Psychiatric illness
• 4. Patients in whom serious illness or disease coexist
• 5. Individual finger amputations in zone two proximal to the FDS insertion
• 6. Amputation with prolonged ischemia time
• 7. Wounds with extensive soil contamination, especially from agricultural injuries
• 8. Ring avulsion amputations
• 9. Small (5th) Digit of Hand
Dr. Garry S. Kitay, M.D. and Bruce Steinberg, M.D Hand surgeons: “Indications - Contraindications For Upper Extremity Replantation”, The Jacksonville Orthopaedic Institute, Hand Center, USA.