Rehabilitation of Amputations in Disasters and Conflicts
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Introduction[edit | edit source]
Natural disasters and mass casualties that occur during military conflicts or industrial accidents can cause musculoskeletal trauma among military and civilian populations involved in these disasters.[1]As a result of crush injury, crush syndrome or compartment syndrome a different than non-disaster approach to amputations may be warrant. [1]
Types of Amputations[edit | edit source]
The level of amputation defines different types of lower and upper limbs amputations.
Upper Limb Amputations[edit | edit source]
Shoulder level:
- Shoulder disarticualtion
- Amputation of the arm, scapula and clavical (Forequater)
Elbow level:
- Above elbow (Transhumeral)
- Elbow disarticulation
- Below elbow (Transradial)
Wrist and Hand level:
- Partial hand (Transcarpal)
- Hand and Wrist disarticulation
Lower Limb Amputations[edit | edit source]
Hip level:
- Hip disarticulation
- Amputation of the leg and pelvis (Hemipelvectomy)
Knee level:
- Above knee amputation (Transfemoral)
- Knee disarticulation
- Below knee amputation (Transtibial)
Foot and Ankle:
- Ankle dysarticulation
- Partial foot (Chopart)
- Syme's
Initial Trauma Care[edit | edit source]
In disaster situations the following principles of trauma care are often critical: rapid triage, transport, early stabilisation, and definitive management.
Rapid Triage[edit | edit source]
Life saving is a primary purpose of limb amputation during the disaster as the wounds sustained at the battlefield usually presents with extensive soft tissue damage, and delayed injury- to- operation time. These are high-energy wounds as compared to wounds sustained during other mass-casualty events (eg. earthquake) which are characterised by low-energy injury, extensive soft tissue damage and late presentation.
Transport and Early Stabilisation[edit | edit source]
Prehospital field amputations may improve patient outcome[2]
In the emergency and disaster medicine literature, it’s generally accepted to amputate the limb as distally as possible.4,6,7 This is consistent with the steering committee recommendations set forth in 2011 by the International Search and Rescue Advisory Group (INSARAG).
Definitive Management[edit | edit source]
increased risk of infection and higher levels of amputation[1]
Medical and Surgical Intervention Considerations[edit | edit source]
Considerations for Amputations[edit | edit source]
Trauma complications:
- crush injury
- crush syndrome Crush syndrome (CS) is a condition with a high morbidity and mortality due to severe electrolyte disorders, circulatory dysfunction and multiple organ failure, secondary to severe rhabdomyolysis and reperfusion injuries. There is controversy about the role of fasciotomy in the treatment of compartment syndromes due to crush injuries and it is still unknown if early amputation has patient-centered benefits.[3]
- compartment syndrome
Healing Considerations[edit | edit source]
Assessment Considerations[edit | edit source]
Treatment Considerations[edit | edit source]
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Resources[edit | edit source]
References [edit | edit source]
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- ↑ 1.0 1.1 1.2 Wolfson N. Amputations in natural disasters and mass casualties: staged approach. Int Orthop. 2012 Oct;36(10):1983-8.
- ↑ Yang C, Ross W, Peterson M. Prehospital field amputation leads to improved patient outcome. J Emerg Med Serv. 2018;43.
- ↑ Arango-Granados MC, Mendoza DF, Cadavid AE, Marín AF. Amputation in crush syndrome: A case report. International Journal of Surgery Case Reports. 2020 Jan 1;72:346-50.
