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INTRODUCTION

Limb amputation is the removal of a part or multiple parts of the lower or upper limb. Studies show that the majority of all lower extremity amputations are due to dysvascular disease. Trauma-related amputations usually occur as a result of motor vehicle, industrial or farming accidents, and war events. Congenital limb deformities account for a small portion of reported limb amputations (up to 3% of reported limb losses). Trauma is the most common cause of amputation during the second and third decade of life. Cancer accounts for approximately 1% of all amputations, and is most common between ages 10 and 20 years. In the developing world, trauma is the leading cause of amputation, and in countries with recent history of warfare or civil unrest, trauma can account for up to 80% of all amputations.1

Amputation has a profound effect on the person who sustains the limb loss, their caregivers, and society. Limb loss has been shown to have detrimental effects on a person's mobility, psychological well-being, quality of life, participation in community, and employment. For persons with multiple limb loss or dysvascular amputation there is reported increase in caregiver burden and significant health care costs. In a study published in 2007 it was found that the lifetime estimated additional cost of transtibial amputation in persons with vascular disease was $509,275 USD.2

Rehabilitation of persons with limb amputation is complex due to the diversity of the patient population; the cause of amputation and the degree of comorbidity in dysvascular patients significantly affect the rehabilitation process. It is important to recognize that rehabilitation must address the amputation-specific impairments of body function; emotional impacts of amputation; mobility recovery, selection, and integration of prosthetic devices; management; and prevention of comorbid and secondary complications. For this reason, a multidisciplinary approach to rehabilitation has long been supported. Research suggests that the presence of a specialized amputation rehabilitation program in an acute rehabilitation hospital is associated with greater degrees of mobility restoration, prosthetic use, return to home, lower mortality rates, and less pain.3,4

EPIDEMIOLOGY

There are several challenges to estimating prevalence of amputation, both within the United States and worldwide. In the United States there is no limb loss national surveillance system. After 1996, the National Health Interview Survey (NHIS) no longer listed “absence of an extremity” as one of its 15 principal conditions and impairments. Although it may be possible to estimate the incidence of amputation according to hospital discharge codes, it is more difficult to determine the prevalence of how many patients with amputation are alive. Regional incidence and cause of amputation also have been found to vary widely. On a more global scale, lack of accurate reporting due to varying availability of health care as well as technologies and record keeping also serve as barriers to information gathering. Nonetheless, in 2005 it was estimated that 1.6 million individuals ...

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