Arm Amputation Solicitors - Medical Negligence Compensation Claims
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An arm amputation involves the loss of a part of the upper extremity. It can be as distal as the fingers or as high as the shoulder. Arm amputations are tricky because, while you can create a lifelike prosthetic device, it is hard to get the prosthesis to actually function like a real hand.
The actual frequency of amputations of the arm is unknown. It is estimated that between 350,000 and one million people are living with an arm amputation in the US. There are rates ranging from 20,000 to 30,000 new cases per year of people who have an arm amputation. Common amputations are not listed�only those with above the elbow lesions.
The amputation is considered one of the world�s oldest medical procedures. They have found archeological evidence of amputations in prehistoric humans. Surgery to correct an acquired traumatic or medically-necessary amputation has come far from the days since �doctors� quickly severed an arm from an unanesthetized person, dipping the stump in boiling oil to stop the bleeding. Now, amputations are done with the idea that a prosthesis should fit and be functional, something begun in World War I. In today�s time there are biomechanics built into most prostheses so the patient can function. Care from the surgeon does not stop with the cutting of the sutures; rehabilitation is very important in amputation care.
The surgeon is challenged by many things in an arm amputation. He or she must first decide how much of the arm is salvageable after an accident. This is an assessment that must be made quickly when trauma is involved. Preserving as much length as possible is important in upper extremity amputations. Even so, it is important to have a viable stump that heals well and is able to accept the best prosthesis possible.
Arm amputation is risky. There can be anesthetic complications, collapse of the cardiovascular system, pulmonary embolus, and infections after surgery. Another big problem that you only see in amputation surgery is contracture of the elbow joint, phantom limb pain, stump breakdown, formation of a neuroma and bony overgrowth (seen in children).
A patient with a traumatic amputation needs more than just a surgeon. He or she needs a comprehensive team of specialists such as those in physical therapy, physiatry, rehabilitative medicine, occupational therapy, prosthetics, and psychology.
These are the primary goals of amputation surgery to the upper extremity:
- Durable coverage of the end of the stump
- Keeping the stump as long as possible
- Preserving sensation as much as possible
- Preventing joint contractures in neighboring joints
- Preventing painful neuroma
- Minimizing short term morbidity and mortality
- Minimizing long term morbidity
- Fitting a prosthetic device early on in the case
- Getting the patient back to work and leisure activities
There are different causes of an arm amputation. These include vascular compromise to the distal extremity, occlusion of an artery in the arm causing gangrene to the distal arm, trauma, such as amputations from chain saws or table saws, band saws or circular saws, crush injuries and other trauma. There can be an arm amputation in war, such as with a mortar blast or heavy gun blast. In such cases, there can be severe blood loss with exsanguination if not treated early.
If there is suspected blood clot in an artery of the arm, the patient may need arteriography or magnetic resonance angiography, also called MRA, which can determine the exact level of the blockage, telling the surgeon exactly where to make the incision for the amputation, if one is necessary. Sometimes the artery can be recanalized so that circulation is preserved. If this doesn�t revitalize the arm, then an amputation is necessary.
Some patients do not need an emergency amputation but have conditions like peripheral vascular disease or diabetes that gradually block the circulation to the arm. Most of these people have already lost their legs due to disease, owing to the longer length of the legs. Usually these people end up with amputations below the level of the elbow instead of an above the elbow amputation. These people get more functional prosthetics than those amputations above the elbow. The extent of the ischemia is the determining factor in what the patient gets in terms of the length of the stump.
Other causes of amputation of the arm are thermal burns, especially in an occupational setting, and frostbite, usually occurring when a person has a prolonged exposure to severely cold temperatures in the winter. Fortunately, the amputations tend to be more in the distal part of the arm�in the fingers and hand. These are like chronic ischemia patients. Doctors must wait until the extent of the injury has declared itself before going ahead and amputating the extremity.
Most traumatic injuries of the arm are not very clear cut. There is crushed and devitalized tissue with avulsion of soft tissue away from bone. There is exposed bone and devitalized tissue left at the stump of the arm. Doctors need to make an educated guess as to where the actual cut should be at the time of surgery. The bony end needs to be smoothed out and enough tissue and skin must be left over in order to wrap around the end of the smoothed bone. When in doubt, the doctors often do an open amputation without closure to see if the residual tissue will be viable so the wound heals appropriately.
Compartment syndrome, left untreated following a crush injury, can result in the need for getting an amputation of the leg. This should involve a fasciotomy to lessen the pressure in the compartments of the forearm. If this isn�t done, the tissue becomes devitalized and should be removed. If too much tissue is devitalized, an amputation is necessary. Doctors try to be as conservative as possible in compartment syndrome, going back to the operating room several times to remove dead tissue, trying to save some skin and tissue. If this cannot be done, an amputation at or below the level of the elbow is necessary.
The author of the substantive medical writing on this website is Dr. Christine Traxler MD whose biography can be read here