Amputation and non-functioning limb salvage: cultural stigma of limb loss

ABSTRACT

Amputation is usually the last resort for treatment of non-salvageable limbs due to various indications such as trauma, infection and malignancy. However, some patients still refuse surgery and reconstruction. Instead, they insist on keeping their limbs despite knowing the negative consequences including a limited or non-functioning limb. We present three cases who refused amputations The first was a nine-year-old boy involved in a motor vehicle accident [MVA], with a left femoral midshaft open grade IIIb fracture; the mangled extremity severity score [MESS] was five. The second was a 16-year-old girl sustained a left leg crush injury, a fractured left fibula and an injury to the anterior tibial artery following an MVA; her MESS was 12. The third was a 60-year-old left-handed tractor driver presented with a fiveyear history of a slowly enlarging fungating growth over the dorsum of his left hand; biopsy confirmed basal cell carcinoma [BCC]. We explore the cultural and religious reasons behind this stigma of amputation in a multiethnic community. It will help clinicians to manage these challenging situations according to the principles of medical ethics