Amputations; "To See My Tears and Hear My Deep-Fet Groans. the Ruthless Flint Doth Cut My Tender Feet," - William Shakespeare (1564-1616), English Playwright King Henry the Sixth, Part 2 (1591) Act II SC IV L. 37-38

Article excerpt

Byline: Dr. Brix Pujalte Jr.

A FEW weeks back, the movie "300" thrilled many and became an instant cult film. It was a high-tech, visually stunning interpretation of the Battle of Thermophylae (480 B.C.). King Leonidas and his Spartans fought so fiercely against the invading Persian army of Xerxes that severed limbs littered the battle grounds. As a doctor, it reminded me of amputations and realized that I have never written about this common procedure.

Definition. "Amputation" comes from the Latin "amputare" and it means "to cut or prune". Anyone, of course, can slash and cut. One needs only to glance at any tabloid for the latest "chop-chop" murder. Now it would be the surgeon who cuts purposively. That is to say, it is the surgeon who amputates. And for what reasons?

* Disease - usually because of the complications of uncontrolled diabetes mellitus

* Trauma - unsalvageable limbs, mostly crushed, because of vehicular crashes or weapons or explosives

* Congenital deformity - birth defects that render the limb vestigial and/or useless.

Is amputation really needed? This is the question on the mind of the doctor before the patient even thinks about it. In the diabetic foot ulcer, the determining factor is the condition of the blood vessels supplying the lower extremity. It is difficult to explain to the patient and family why the suggested level of amputation is below the knee when all they see is gangrene of the foot. Why not just remove the rotting parts? Here is where the expertise of the vascular surgeon comes in. This specialist checks if the extremity can survive if the blood vessels are repaired or resected and grafted in such a way that a stronger, continuous, and more reliable blood supply results.

There is also the matter of the patient's health and how many operations she can tolerate.

Most elderly patients can survive one definitive procedure - the amputation - but weaken and succumb if the family decides on piecemeal amputations (the foot, then the ankle, then the leg, and so on).

Don't be a candidate (for amputation). If you are diabetic, poor circulation can be problem. So what happens is that peripheral areas - the feet most especially, may not get enough blood for nourishment. Damage to the feet is also compounded by the decrease or lack of sensation (another effect of diabetes). You should, to stave off amputation:

* Stop smoking

* Control weight

* Monitor every day blood glucose levels

* Check every day the feet for wounds, blisters, redness, or swelling (get a magnifying glass or ask someone to do it for you if vision is bad)

* Exercise (with doctor's clearance)

* Monitor sensory changes - numbness, "pins and needles" in the hands and feet. …