Multiple extremity amputation, also known as multiple limb amputation, is when two or more limbs are amputated, including due to congenital factors. Multiple extremity amputation includes the common terminology of double amputation, triple amputation, or quadruple amputation based on the number of extremities affected. Along with amputations resulting from trauma, many individuals with multiple amputations have endured them as a result of dysvascular disease. Over recent years, amputations as a result of dysvascular disease have risen to comprise more than 80% of new amputations occurring in the United States every year. Currently, there are approximately 1.6 million individuals in the United States with multiple extremity amputations.
Currently, 25.8 million people are impacted by diabetes in the United States, which is expected to double by the year 2030. Those with diabetes have an approximately tenfold increase in the risk of amputation than those without diabetes. Approximately 55% of individuals who sustain an amputation secondary to vascular disease and diabetes will require an amputation of the contralateral limb within two to three years.
Medical advancements have reduced amputations due to trauma. Despite the decline, trauma remains the second most common cause of amputation in the U.S. The mechanism of injury is predominantly blunt force, although penetrating injury can also lead to amputation and typically results in a more severe injury overall. The most common causes are motor vehicle collisions (45.7%) and railway accidents (19.9%). The average age of those injured was 37.2 years old, significantly younger than those who typically have a dysvascular-related amputation.
Although not the most predominant cause of multiple amputations, the military conflicts since 9/11 in Iraq and Afghanistan have brought traumatic amputation to the forefront of all etiologies, the most recent reports from these conflicts indicate that 510 individuals have lost more than one limb. The injuries encountered are typically secondary to blast injuries and are usually accompanied by a host of comorbidities ranging from additional fractures, soft tissue damage, and peripheral nerve injury to traumatic brain injury (TBI), post-traumatic stress disorder (PTSD), and other behavioural health problems. Additionally, these patients are typically significantly younger than even those civilians who have suffered traumatic amputations.
Limb loss due to cancer is rare compared to both vascular disease and trauma. When it does occur, it is most often the result of malignant bone tumours, which comprise 6% of all cancers in those less than 20 years old. Osteosarcoma and Ewing sarcoma are the most common bone malignancies in the long bones and central axis, although other cancers have also been implicated in leading to amputation. Cancer-related amputations are most likely in the lower limbs. The rate of amputations caused by malignancies has been decreasing along with traumatic amputation due to advancements in the early detection of cancers and improvements in their treatment.
Congenital limb deficiency can result from genetic variation, exposure to environmental teratogens, or gene-environment interactions. The rate of any amputation is very low, comprising about 0.8% of all amputations, consisting of 26 per 100,000 births.
Those with multiple extremity amputations face many rehabilitation challenges, each resulting from the unique circumstance of that particular individual. Careful considerations are required to optimize the initial medical and surgical management, minimize behavioural health issues and achieve proper pain control, all of which are necessary to maximize the chance of success of the rehabilitation process. Close multidisciplinary collaboration between the surgical team, medical team, physiatrists, pain team, physical and occupational therapists, recreational and sports therapists, and prosthetists is essential to the success of the complex rehabilitation process. Social and family support is essential and can be maximized through both traditional and non-traditional channels, such as support groups and peer visits. Most importantly, patient involvement from the very beginning of this process is absolutely necessary to identify realistic long-term goals for the patient, which are the guiding posts for the rehabilitation process.
Many with multiple extremity amputations require the use of a power wheelchair. Powerchairs incorporate power-adjustable seating for user repositioning and comfort; speciality drive controls, including such options as using one’s head to operate the powerchair; and a highly adaptable design to meet an individual’s needs.
Powerchairs feature the latest advanced technologies to increase the independence of those living with multiple extremity amputations. iLevel seat elevation technology allows a user to operate the powerchair at seated or standing height. Bluetooth is also integrated into Quantum’s Q-Logic 3 electronics, so those with multiple extremity amputations can operate much of their environment with the powerchair drive control. Powerchairs are designed to provide optimal medical comfort and maximum independence for those with multiple extremity amputations.
The Quantum Edge 3 with industry-first 4.5 mph at iLevel offers the most advanced power chair experience ever. Q6 powerchair series, which includes the Edge 3 and Q6 Edge 2 powerchairs, provide highly adjustable mid-wheel drive power bases. The Q6 Edge 2 all accept our optional iLevel technology, which offers up to 12 inches of lift at 4.5 mph. The 4Front is a quiet, more responsive front-wheel drive power chair that features automotive-grade suspension with unprecedented comfort and rides quality.