Frequency, causes and consequences of an amputation – frequent amputation leg, amputation lower leg

1: Epidemiology – Frequency of amputations in Germany

Altogether the number of the amputations in Germany is in the last years increasingly. However, there are now fewer major and more minor amputations. Causes are v.a. the growing number of cases due to (old-age) diabetes (keyword: diabetic foot syndrome) and circulatory disorders, which are often the result of obesity, smoking and lack of exercise. In recent years, there have been between 60.000-80.000 amputations in Germany. These numbers fluctuate and there is no exact data, because until today a central amputation register is missing in Germany. However, it is safe to say that the number of amputations in Germany is among the highest in comparison to other European countries (per 100.000 inhabitants). At this point in time, we can only speculate about the reasons for this.

Source: German Society of Angiology 2011; Federal Health Report 2015

You are also welcome to watch this video of Dr. Tobias Weigl to this topic to. In detail, he goes into the various causes and distinguishes v.a. between the causes and frequencies of the sog. Micro versus macro amputations.

Related topics and suggestions

THE PAIN MEMORY – How a pain memory develops. The editorial pain memory to read.

HOLISTIC MULTIMODAL PAIN THERAPY. The multimodal pain therapy for further reading.

Amputation injuries in the area of the upper extremity (the arms) show an age peak between the 20. and 40. Year of life. The most common are the so-called. Microamputations, v.a. Thumb and finger amputations. Microamputations, i.e., amputations v.a. in the area of the hand, are up to 15 times more frequent than amputations of the entire lower and/or upper arm. Males are affected 4 times more often than females; there is no side preference (i.e., whether right or left).
In the area of the lower extremity, d.h. of the legs, amputations occur most frequently in the lower leg area. Thigh amputations are rare (but more common in wartime).

2: What are amputations?

A distinction is made between macro- and micro-amputation injuries. In the upper extremity, i.e. in the arm, the limit is the so-called. Radiocarpal joint. If an amputation has to be performed proximally, d.h. performed in front of the joint, it is called a macroamputation. On the other hand, in the case of an amputation distal, d.h. behind the joint, a microamputation injury before.
In the lower extremity, i.e., the legs, the limit is the so-called. Upper ankle joint (OSG). Amputations in front of the ankle joint, i.e. proximal, are called macroamputations, while distal to the ankle joint are called microamputations.

3: Etiology – cause of amputations

90% of all amputations are so-called. Microamputations. These include amputations of fingers, toes or even feet. The main cause is 90% circulatory disorders, which in turn are the result of diabetes, smoking, obesity and other factors. Over 60.000 of all annual amputations in Germany are thus the result of circulatory disorders. Accidents (4%) and tumors (4%) are much rarer in comparison.

Source: Kern 2009; Ruchholtz and Wirtz 2013; arztezeitung 2013; own calculations.

As described above, only ca. 10% of all amputations sog. Macroamputations, d.h. Amputations of the thigh or the entire arm. If these amputations do occur, they are understandably very consequential for the affected person. Causes are – in contrast to microamputations – to ca. 60% accidents resp. trauma, in the order of occupational accidents (>50%), traffic accidents (approx. 18%), agricultural accidents (ca. 15%) as well as accidents with chain saws (ca. 10%). Less frequent, however, are macroamputations due to tumors, circulatory disorders and diabetes (overall, diabetes is of course the main reason for an amputation, but as described above, it is mostly accompanied by microamputations (z.B. fingers, feet).
Typical but very rare in the area of the feet are amputations due to lawnmower injuries.

Source: Kern 2009; Ruchholtz and Wirtz 2013; own calculations.

In addition, the causes can also be differentiated according to age and amputation level. Here, too, you can find abnormalities or. Special features. The following tables summarize the findings.

Source: Baumgartner and Botta (1989); Baumgartner et al. (2008); Kern et al. (2009).

Source: Baumgartner and Botta (1989); Baumgartner et al. (2008); Kern et al. (2009).

4: Amputations due to diabetes

In diabetes, the pancreas does not produce enough insulin. Insulin is important, however, because it transports glucose ingested with food from the blood to the cells of the liver, kidneys, muscles and brain. Thus, if not enough insulin is produced, glucose remains in the blood, resulting in elevated blood glucose levels. As a result, glucose is deposited in the body and especially in the blood vessels and nerve tracts. This can lead to circulatory disturbances and nerve damage, which particularly affects the lower extremities. Typical is then the diabetic polyneuropathy, which belongs to the group of neuropathic pains.

In this video, Dr. Tobias Weigl everything important around the topic diabetic polyneuropathy. Causes and treatment options.

The deposited sugar clogs the nerves that are responsible for transmitting pain sensations. Affected persons therefore no longer perceive pain, as it is not transmitted to the brain. If, for example, a foot is injured, this signal does not reach the brain, where it would be processed further. For this reason, sufferers continue to put weight on the foot, which aggravates the injury. In addition, deposits of sugar cause blood flow to be disrupted. This means that the foot is not supplied with sufficient oxygen. If there is an injury to the foot, it can become infected. The combination of nerve damage and circulatory disturbance leads to the death of cells and tissue, and amputation can be the result. In this context, there is also talk of diabetic foot syndrome and Charcot syndrome.

5: Amputations due to peripheral arterial disease (pAVD)

Peripheral arterial occlusive disease is caused by a circulatory disorder. This is caused in most cases by arteriosclerosis. This is a disease of the blood circulation and the vascular system, which is characterized by a narrowing and calcification of the arteries.
Normally, the blood in the lungs is enriched with oxygen. Oxygen is transported from the heart to the entire body through the arteries. In peripheral arterial occlusive disease, this process is disturbed because the calcified and narrowed vessels no longer supply enough oxygen to the individual regions of the body. As a result, the tissue is no longer supplied with sufficient blood and the cells die off. The greatest risk factors for peripheral arterial disease are smoking, diabetes mellitus, elevated blood lipids and high blood pressure.

6: Amputations due to cancer

Patients suffering from malignant bone cancer may also be affected by amputation. In most cases, this leads to an amputation of the thighs, lower legs or upper arms. Doctors consider this step to prevent the cancer cells from spreading and affecting other parts of the body.

7: Amputations due to accidents

If, in the case of a traffic or work accident, the injury is so severe that severed nerves or vessels cannot be rejoined or saved, amputation is performed. The lower legs and forearms are most commonly affected.

8: When is an amputation performed and what are the risks??

Amputation is only carried out to prevent worse. It is only considered if a part of the body has been so severely damaged that it can no longer be saved. Amputations are also performed when tissue on the body has died off. Dead tissue poses a risk that should not be underestimated. This can cause infections, which then spread throughout the body via the blood.
Complications can occur in the course of an amputation. The wound may become infected and there may be secondary bleeding around the residual limb and wound healing problems. Wound healing is particularly impaired when the affected person is physically weakened and the immune defense is lowered. In addition, circulatory disorders and pre-existing conditions such as diabetes mellitus have a negative effect on wound healing.
However, complications do not only occur directly after the operation, which are mainly associated with a disturbance of the healing process. Even later, problems can occur that are not the direct result of the operation. These mainly include stump pain and phantom limb pain.

9: What can those affected do in the event of an amputation??

First and foremost, it is important that affected persons are supported. Support from friends and family is just as important as professional help from doctors, psychologists and self-help groups.
Affected persons must prepare well before amputation. You should receive detailed information about the operation and its course in advance so that all uncertainties are cleared up and all pressing questions are answered. Furthermore, it is helpful, even if it is difficult, to find the right attitude towards amputation. This should not be seen as the loss of a body part, but as an inevitable measure to improve health and life situation. In addition, it is important that patients trust the doctors who will perform the surgery.
After the operation, affected persons must learn to cope with the new situation, because many restrictions and changes are associated with the amputation, which affect both the personal and professional level. To get back to life, patients should work closely with professionals from different medical fields. Together with them, they work on their mobility and agility. They also receive help getting used to their prosthesis and learn how to use it in everyday life. Similarly, specialists monitor wound healing directly after the operation and can provide patients with psychological counseling and care. Attending a rehabilitation center is particularly recommended after an amputation, because in a facility designed for this purpose, patients receive all the support they need in this situation. In addition, they are in good hands in a rehabilitation clinic if they suffer from phantom limb pain and residual limb pain, since a wide range of therapy options are available to them there. Therapy for amputation pain should always be multimodal and holistic. It has been proven that better therapy results can be achieved through intensive care and continuous treatments.

How Small Fiber Matrix Stimulation (SFMS®) works

10: Summary: Short& short

No reliable statement can be made about the frequency of amputations. In Germany, there is no register that records the official number of amputations per year. However, it is estimated that around 60.000 amputations performed in Germany. In most cases, amputations affect the lower extremities, i.e. the toes, the feet, the lower legs and the legs. If an amputation has to be performed, it can be for a variety of reasons. Most amputations are performed in diabetics, with people with type 2 diabetes mellitus being particularly affected. Because it is estimated that 70-80% of amputations performed in Germany are due to diabetes mellitus. Thus, the risk of amputation is about 15 to 25 times higher for diabetics compared to people who do not have diabetes. Men are affected more often than women. Amputation can also occur as a result of peripheral arterial occlusive disease, cancer or an accident.

11: Further links and sources

R. Baumgartner and P. Botta (1989): Amputation and prosthetic fitting of the lower extremity; Thieme.
R. Baumgartner and P. Botta (1989): Amputation and prosthesis care; 3. Edition, Thieme.

U. Kern et al. (2009): Prevalence and risk factors of phantom pain and phantom perception in Germany.U. Kern et al. (2012): Phantom limb pain in daily practice – Still a lot of work to do!S. Ruchholtz and C. D. Wirtz (2012): orthopedics and trauma surgery essentials: intensive course for continuing education; Thieme.

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This article was published on 05.03.2017 in the blog article section .

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