DRG Category: 239

Mean LOS: 15.5 days

Description SURGICAL: Amputation for Circulatory System Disorders Except Upper Limb and Toe with Major CC

DRG Category: 908

Mean LOS: 6.5 days

Description SURGICAL: Other Operating Room Procedures for Injuries with CC

classification section:



Amputation is the surgical severing of any body part. Amputations can be surgical (therapeutic) or traumatic (emergencies resulting from injury). The type of amputation performed in the Civil War era by a surgeon called a "sawbones" was straight across the leg, with all bone and soft tissue severed at the same level. That procedure, known as a guillotine (or open) amputation, is still seen today.

A traumatic amputation is usually the result of an industrial accident, in which blades of heavy machinery sever part of a limb. A healthy young person who suffers a traumatic amputation without other injuries is often a good candidate for limb salvage. Reattachment of a limb will take place as soon as possible following the injury. The chief problems are hemorrhage and nerve damage. A closed amputation is the most common surgical procedure today. The bone is severed somewhat higher than the surrounding tissue, with a skin flap pulled over the bone end, usually from the posterior surface. This procedure provides more even pressure for a weight-bearing surface, promoting healing and more successful use of a prosthesis. (See Table 7 for levels of amputations.)

Levels of Amputation

Note: Note: The terms below the knee amputation, or BKA, and above the knee amputation, or AKA, are also commonly used.

TYPE	DESCRIPTION
Below the knee	Most common surgical site, performed rather than above-the-knee amputation whenever possible because the higher the amputation performed, the greater the energy required for mobility.
Syme procedure	Partial amputation with salvage of the ankle; has advantages over loss of the limb higher up because it does not require a prosthesis and produces less weight-bearing pain.
Transmetatarsal/toe amputation	Involves removal of limited amount of limb; requires little rehabilitation; often followed by additional surgery at a higher level because of inadequate healing when used for patients with peripheral vascular disease.
Hip disarticulation/extensive hemipelvectomy	Usually performed for malignancies; because of the surgery involved and the extremely bulky prosthesis required for ambulation, these procedures are used either as life-saving measures in young patients or as a surgery of last resort for pain control.
Upper extremity	Performed with salvage of as much normal tissue as possible. Function of the upper extremity is vital to normal activities of daily living. Much research is being conducted at the current time to manufacture and refine prostheses that can substitute for the patient's arm and hand, providing both gross and fine movement. Cosmetic considerations are extremely important in the loss of the upper extremity for many patients.