Riska, Forever Spookin’

The technique for a provisional amputation is often referred to as guillotine.

In the past, this approach was commonly used in battle situations where speed was important to minimize both blood loss and subsequent infection.

The technique is used mainly to remove a victim from a dangerous situation, typically one causing a crushing injury in which the alternative to amputation is death.

All tissues are cut circularly.

Skin is retained to the greatest degree possible, muscle and fascia are cut shorter, and the bone is cut shorter still.

The hope is that the soft tissues (skin and muscles) will ultimately cover the bone, but the results are generally unsatisfactory.

Large scars are common, and muscle frequently adheres to the bone.

Long periods are required for healing, infections are common, and prostheses do not fit well.

Another, more definitive amputation is usually required at a later date.

In a conventional amputation, skin, underlying tissues, muscle, and fascia are all cut in curved flaps that originate at the end of the remaining, unamputated bone.

The muscles, fascia, bone, and major blood vessels are divided at the base of the remaining bone; nerves are cut at a slightly higher level, approximately 2.5 centimeters (1 inch) above the end of the bone.

The nerves will retract somewhat into the muscle, minimizing postoperative pain.

Muscles are tapered so that large masses of tissue are not present over the end of the stump; this will enhance the fit of a later prosthesis.

At the cut end of the bone, the outer layer of bone is removed to reduce the possibility of bone spurs forming in the future.

The skin over the amputation site is closed loosely to avoid stretching as it heals.

The purpose of an osteomyoplastic amputation is to improve function after a prosthesis is fitted.

The preparation of skin and fascia is the same as for a conventional amputation.

Nerves and blood vessels are also divided.

Muscles are separated for about 5 centimeters (2 inches) past the point where the bone will be cut.

A portion of the outer surface (periosteum) of the bone to be amputated is sutured to the divided muscle.

The bone is then cut.

The prepared flap of periosteum and muscle is sutured to the periosteum of the stump.

This procedure covers the marrow cavity of the stump, helps to preserve the remaining bone, and reduces postoperative infections.

The remaining muscles are then sutured across the end of the stump.

The skin is closed as in a conventional amputation.

In an alternative procedure, holes are drilled in the bone of the stump.

Muscles are inserted in the holes and sutured in place.

The net effect of these osteomyoplastic procedures is to strengthen the musculature of the stump and to improve mobility for a prosthesis.

There are several common sites or levels for amputations of the leg.

Syme’s amputation is performed when most of the foot has been destroyed by trauma or compromised by poor circulation. In this type of amputation, the bones of the foot are removed, and the end of the tibia becomes the weight-bearing surface for the prosthesis.

A below-the-knee (BK) amputation is used to provide additional mobility for a prosthesis. It also leads to more complete rehabilitation because the knee is still available for movement. It is also associated with a reduction in phantom limb pain.

An above-the-knee (AK) amputation is frequently selected when gangrene extends into the muscles or skin of the calf. When the muscles of the leg are contracted, a prosthesis is not likely to be fitted or used. There is no advantage to a BK amputation in this situation. The AK amputation is associated with the highest healing rate for amputations among patients with peripheral vascular disease. The rate of a repeat amputation performed at a higher level on the leg is also low. Prostheses that permit walking, however, are less efficient with amputations at this level.

Both amputations have about the same rate of healing, but a higher percentage of individuals with BK amputations walk on prostheses than do those with AK amputations.

The choice between BK and AK amputation is determined by the general health of the patient and the potential for rehabilitation.

The most important determinant of the level of amputation, however, is the vascular status of the patient.

The leg can also be amputated at either the knee or the hip; such a procedure is a disarticulation, an amputation through a joint.

A knee disarticulation is most commonly used with children to preserve the growing portion (epiphysis) of the remaining thigh bone.

A hip disarticulation is used with tumors or extensive soft tissue injuries in the thigh.

Special prostheses that permit walking after such procedures are available, but are relatively uncommon.

However, as technology improves, such prostheses are becoming more widely available and increasingly comfortable and functional.

Portions of the upper extremity are usually amputated after extensive trauma.

Malignant disease of the bone or muscle is a less common reason for amputation at these sites.

The considerations described for the lower extremity apply to the upper extremity, namely, preserving as much tissue as possible for later rehabilitation and recovery of function.

The sites for amputation are also analogous. Individual fingers can be amputated, or the entire hand can be amputated at the wrist (a location similar to the Syme’s amputation of the foot).

Similarly, the forearm can be amputated either below the elbow or above the elbow.

Portions of the arm can be disarticulated at the elbow or at the shoulder.

Restoration of function is far more difficult, however, in an upper extremity amputation than for a lower extremity amputation. It is easier to restore the ability to walk than it is to restore hand function.

Possible Causes

A person can experience a traumatic amputation from a motor vehicle, occupational or industrial accident or combat injury.

Traumatic injury accounts for about 45% of all amputations.

A body part can be cut off or torn away in a severe accident, or it can be so badly damaged from a crush injury or severe burns that it cannot be saved.

If tissue destruction, infection or disease affects a body part in a way that makes it impossible to repair or endangers the person’s life, that part may be removed by surgical amputation.

Trauma or disease that cuts off blood flow to a body part for an extended time can also cause tissue death requiring an amputation.

An example is frostbite, which can damage the blood vessels in fingers and toes, eventually requiring their removal.

LIMB LOSS. People can lose all or part of an arm or leg for many reasons. Common ones include:

Problems with the flow of blood through your body. These may be the result of atherosclerosis or diabetes. Severe cases may result in amputation (the surgical removal of a limb).

Injuries, including from traffic accidents and military combat.

Cancer.

Birth defects.

Common feelings following an amputation

The loss of a body part, especially one as visible as a finger, hand or arm, can be emotionally upsetting.

It may take time to adapt to changes in physical appearance and ability to function.

Talking about these feelings with a doctor, therapist, or other patients who have had amputations often helps patients come to terms with amputation.

You may ask your doctor to recommend a counselor to assist with this process.

It is important to remember that with time, patients adapt by finding new ways of doing daily activities.

A resource that may help is the Amputee Coalition of America.

Remember that the quality of life is directly related to one’s attitude and expectations – not just obtaining and using a prosthesis.

Some amputees have phantom pain, which is the feeling of pain in the missing limb.

Other physical problems include surgical complications and skin problems if you wear an artificial limb. Many amputees use an artificial limb. Learning how to use it takes time. Physical therapy can help you adapt.

Recovery from the loss of a limb can be hard. Sadness, anger, and frustration are common. If you are having a tough time, talk to your health care provider. Treatment with medicine or counseling can help.

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In the Egyptian civilization's writing system, called hieroglyphics, the symbol for love translated to "a long desire."

One of the most famous examples of unrequited love in history involves medieval Italian poet Dante and his muse, Beatrice Portinari.

Dante fell in love with Portinari at first sight when she was only 9 years old, but the poet was promised to marry someone else.

After Portinari's death in 1290, Dante chronicled his secret love for her in La Vita Nuova in 1295.

She also appears as his guide through Heaven in The Divine Comedy, completed in the early 1320s.

Unrequited love can manifest itself in different ways.

It can start as a crush,

which develops into a long-standing infatuation.

Admirers may desire someone from a distance, never telling the individual about their romantic feelings.

Conversely, unrequited lovers may relentlessly pursue the object of their affection, making their intentions known.

There are 2 main paths to unrequited love.

The attraction can be based on an existing connection or

the pursuit of someone more desirable.

Most often, unrequited love grows out of platonic friendships.

One friend may feel an underlying attraction toward the other.

It can develop in the workplace when a coworker has feelings for another employee.

It can spring up when a former flame wants to rekindle a romance.

Unrequited love can also occur during a mutually satisfying relationship when a person decides to leave, but the other individual is still in love.

Admirers may encounter unrequited love when they find someone more attractive than they are.

The person may possess physical qualities or personality traits that appeal to the would-be lover.

Pursuers may be drawn to the individual's beauty, sense of humor, or intelligence.

Unrequited love is quite common.

According to a 1993 study by psychologist Roy Baumeister, 98% of the participants said they had experienced unrequited love.

Men are more likely to fall for someone who does not return their affection, the study found.

Unrequited love is full of emotional highs and lows.

The experience can be painful for both admirers and the objects of their devotion.

Unrequited lovers sustain their passion for their beloved through hope.

They are optimistic the objects of their affinity will one day love them back.

Eventually, however, the admirers become disillusioned, realizing their efforts are fruitless.

The failure to pursue the one they love can leave unrequited lovers feeling hurt, humiliated, and depressed.

The stinging defeat of rejection can erode their self-confidence.

Most stories about unrequited love focus on the agony of the admirer, but the recipient also suffers:

At first, the objects of unwanted affection are initially flattered by the would-be lovers' attention.

However, as time goes on, the beloved must deflect unsought advances.

The recipient may become frustrated by the unrequited lover's persistent pursuit.

Recipients of unrequited love also feel guilty for wanting to reject their suitors, but they are afraid of hurting their feelings.

Instead of spurning them outright, the beloved individuals may avoid telling their pursuers the truth—that they do not share their romantic interest—and hope the infatuation fades.

To lessen the blow during rejection, the beloved individuals may also sugarcoat their words, saying they are not interested in a relationship at the current time.

However, this strategy can backfire:

The appeasing language may give the would-be lovers just enough hope to hang on to the possibility of a future romance.

In extreme cases, admirers' unrequited love can turn into obsession and stalking.

Unrequited love results in unhappiness and heartbreak. Admirers can cope with doomed relationships in 3 ways:

First, unrequited lovers must accept the reality of the situation. Pursuers must admit the objects of their devotion do not love them back. It does not mean the unwanted suitor is undeserving or unattractive.

Second, admirers must acknowledge rejection and the feelings that accompany it, including sadness and loneliness. They may realize they were not the right partner for their beloved, and vice versa.

Finally, unrequited lovers should minimize contact with the recipients of their affection. They are mourning the loss of a relationship they never had, but keeping in touch could keep the hope of having one alive. A clean break allows the admirer to move on from the infatuation.

Unrequited love is a common theme in literary works.

French dramatist Edmond Rostand's 1897 play Cyrano de Bergerac follows the noble soldier Cyrano, a gifted poet in love with his beautiful cousin Roxane.

Cyrano, ashamed of his large nose, helps the handsome cadet Christian woo Roxane by writing romantic poetry to her under Christian's name.

In The Hunchback of Notre Dame, written by French author Victor Hugo in 1831, deformed hunchback Quasimodo falls in love with the stunning gypsy Esmeralda after she shows him kindness.

After Esmeralda is hanged, Quasimodo kills the priest responsible for her death.

American writer Margaret Mitchell's epic 1936 novel Gone with the Wind follows selfish Southern belle Scarlett O'Hara, who is in love with the mild-mannered Ashley Wilkes.

Ashley loves his cousin Melanie, but he does not fully reject Scarlett's feelings, which she hangs on to despite her many marriages.

The romance was adapted into a cinematic masterpiece in 1939.

Unrequited love is a phenomenon that almost everyone experiences. As people search for true love, they will likely encounter unrequited love and the heartbreak it brings on the way to finding a lasting relationship.