2008年3月21日金曜日

History
Amputation is derived from the Latin amputare, to cut away, from amb (about) and putare (to prune). The Latin word has never been recorded in a surgical context, being reserved to indicate punishment for criminals. The English word amputation 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.

Amputation Origins of the word
The history of human amputation can be divided into a number of periods. Initially the many thousands of years when limb loss was the result of trauma or 'nonsurgical' removal. This was followed by the hesitant beginnings of surgical intervention, mainly on gangrenous limbs or those already terribly damaged, which developed through to surgical amputations around the 15th century, the distinction is marked by the choice of the patient and the aim of saving a life and achieving a healed stump, despite the difficulties with infection and the lack of effective control for pain or blood loss. Improvements in surgical techniques were married with better haemorrhage control in the 19th century and in the 1840s with anaesthesia and around twenty years later efficient infection control. The 20th century noted marked improvements in surgical techniques and also a move to increasingly sophisticated prosthetic limbs.

Overview
Types of amputation include:
Hemicorporectomy, or amputation at the waist, is the most radical amputation.
Genital modification and mutilation may involve amputating tissue (as the case is with circumcision), although not necessarily as a result of injury or disease.
As a rule, partial amputations are preferred to preserve joint function, but in oncological surgery, disarticulation is favored.
Reasons for amputation

leg

  • amputation of digits
    partial foot amputation (Chopart, Lisfranc)
    ankle disarticulation (Syme, Pyrogoff)
    below-knee amputation (transtibial)
    knee-bearing amputation (knee disarticulation)
    above knee amputation (transfemoral)
    Van-ness rotation (Foot being turned around and reattached to allow the ankle joint to be used as a knee.)
    hip disarticulation
    hemipelvectomy
    arm

    • amputation of digits
      metacarpal amputation
      wrist disarticulation
      forearm amputation (transradial)
      elbow disarticulation
      above-elbow amputation (transhumeral)
      shoulder disarticulation and forequarter amputation
      Krukenberg procedure
      teeth

      • The avulsion of some teeth (mainly incisives) is or was practiced by some cultures for ritual purposes (for instance in the Iberomaurusian culture of Neolithic North Africa).
        Cancerous bone tumours (e.g. osteosarcoma, osteochondroma)
        Severe limb injuries in which the limb cannot be spared or attempts to spare the limb have failed
        Circulation problems
        Deformities of digits and/or limbs
        Any advanced cancers
        Gangrene
        Bone infection (osteomyelitis)
        Traumatic amputation (Amputation occurs actually at scene of accident, the limb can be partially or wholly severed)
        Amputation in utero (Amniotic band)
        Mastectomy (amputation of breast) for breast cancer Types and causes
        The first step is ligating the supplying artery and vein, to prevent hemorrhage. The muscles are transected, and finally the bone is sawed through with an oscillating saw. Skin and muscle flaps are then transposed over the stump, occasionally with the insertion of elements to attach a prosthesis.

        Method
        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 his own limb:
        Even rarer are cases where self-amputation is performed for criminal or political purposes:
        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 can not save the limb, or by causing the limb to be severed.

        In 2007, 66-year old Al Hill amputated his leg below the knee using his pocketknife after the leg got stuck beneath a felled tree he was cutting in California. [2]
        In 2003, 27-year old Aron Ralston amputated his forearm using his pocketknife and breaking and tearing the two bones, after the arm got stuck under a boulder when hiking in Utah.
        Also in 2003, an Australian coal miner amputated his own arm with a Stanley knife after it became trapped when the front-end loader he was driving overturned three kilometers underground. [3]
        In the 1990s, a crab fisherman got his arm caught in the winch during a storm and had to amputate it at the shoulder, as reported in The New Englander.
        Documentary filmmaker Errol Morris was ordered to "leave town within twenty-four hours or leave in a casket" by the unnamed "king of the nubbies" of the town of Vernon, Florida (which Morris called "Nub City"), when he was researching a documentary about a bizarre scam wherein individuals would cut off their own limbs as a way to collect insurance money.[4] The final version of Vernon, Florida contains no references to this scam.
        On March 7, 1998, Daniel Rudolph, the elder brother of the 1996 Olympics bomber Eric Robert Rudolph, videotaped himself cutting off one of his own hands with an electric saw in order to "send a message to the FBI and the media." [5] Amputation After-effects

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