Monday, July 13, 2015

Medical Mondays: Dealing with a Fictional Amputation

Hello friends! I received this question recently, and it brings up a lot of the fictional issues that can come with a surgical procedure. The question comes from Deb Salisbury, a blogging friend and an expert in historical fashions.

My thirteen year old MC injured his foot, contracted gangrene, and had his foot amputated at the ankle.

Would he be up and wandering around town on crutches after ten days? Or twenty?

After six months of good healing, how much trouble would he have walking in a wool-stuffed boot if he lost his crutch? Would blisters or sores form if he wasn't used to it? At the very least, he's emotionally dependent on his crutch, in my story. Would he still be physically dependent on it?

FYI: The story is fantasy in nature, and there are magical elements in the world, which will be helpful for staving off infections. I would also assume that surgery wasn't terribly sophisticated, as we are dealing with pre-modern techniques and instruments in this world. 

There are also a few more assumptions. First, that the character at baseline is healthy (this matters for wound healing and general strength). Second, that there were no complications to surgery (I know--this is a BIG assumption. Historically, amputees often died soon after surgery from massive hemorrhage or infection. But for this story, we need our character alive and only with an amputation. So. Let's assume the surgeon/medical person could somehow tie off or cauterize blood vessels, creative a nice flesh flap to cover the wound, and sew it all up nicely). In this idealized case, the superficial aspect of the wound ought to heal within two to three weeks. 

However, the deeper parts of the leg tissue from the amputation itself takes a longer time to heal, up to eight weeks, and even then it's a continuum of healing. So I was glad to hear that he wasn't faced with using a prosthesis soon after surgery, which might not be realistic in this world. 

He probably could use crutches within a few days after the surgery, and using a prosthesis at the six month mark would likely be okay. It would be tough on him, though, because I'm assuming without modern prosthetics, the boot won't fit great, the wool would be rough and he hadn't yet "hardened" his stump to this kind of pressure and stress yet. There would be issues with blisters and stress on the skin. His muscles in that leg would also be weak from disuse (no tried and true physical and occupational therapists in this fantasy), so he'd have to deal with that too. At the beginning of using the prosthetic boot, my guess is he'd be dependent on the crutch, but not after he got used to it and built up his stamina. 

For more information, here's a great overview by Johns Hopkins on dealing with an amputation before, during, and after the surgical period. 
Here's the National Amputation Foundation website with FAQs for new amputees. 
This is a great essay on the history of amputation, by Meghan Wooster. 
And also for history's sake, this is a great Pinterest board with photos of historical prosthetics. 

Thanks Deb for a great question!


Natalie Aguirre said...

Thanks for the info and links. In my new job, I write library, blog and FAQs for attorneys about injuries. Sometimes it's about amputations so I appreciate the links, which I'm saving.

Alex J. Cavanaugh said...

Just surviving it would be a big step. Make you thankful for the miracle of modern medicine.

Deb Salisbury said...

Thanks for your help, Lydia! Much appreciated. :-)

Dianne K. Salerni said...

Great information -- and it's always a great thing when what you've planned for the story is actually possible! ;)

Southpaw HR Sinclair said...

Great info. Thanks Lydia.

Angela Brown said...

This is great information that can be very helpful in making amputation content in a story far more realistic.

Kelly Steel said...

Thanks for these great informational post. I write medical romances so this is very handy!

J E Oneil said...

It's quite gruesome to read about. I'm glad I don't have an amputation scene to write.

SA Larsenッ said...

Thanks for the intriguing question. And I'll second Alex's comment. I'm thankful for all the medical advancements we have today.

Leslie S. Rose said...

These posts always fascinate me. I know how long it took me to recover from hip replacement. I can't imagine the tribulations of a post-amputation journey.

alexia said...

Super interesting!!

Eva Inka Nurmaisya said...

Banned complain !! Complaining only causes life and mind become more severe. Enjoy the rhythm of the problems faced. No matter ga life, not a problem not learn, so enjoy it :)

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