# Amputation



## DragonOfTheAerie (Oct 28, 2016)

Ok, so, there may not be much point in posting this, since this is waaaaaay down the road in my writing. Like, 5-6 years, before I'll actually write this. But, I would like to start some discussion on it all the same. 

Basically, one of my characters gets a limb amputated, specifically his dominant arm at the shoulder. I'm not sure what exactly causes the injury that necessitates this, so suggestions are appreciated and might lead to inspiration, but I do know that it happens. 

This character is pretty important to the story (he's one of the MC's, actually, and a POV character) so this is going to have a profound effect upon the story. Recently I've realized that this will be incredibly hard to pull off. Possibly one of the toughest things I'm going to have to write. I'm going to have to have a huge amount of authentic detail about something I know NOTHING about. I'm almost convinced that I will have to talk to someone who has been through this to tell the story properly. However, I do have a few specific questions that the scribes may be able to answer: 

After the amputation, what would the healing process be like? This is a low tech setting without modern medicine. I don't know yet what exactly they use to amputate the limb...I was thinking a saw earlier, but I then realized they probably wouldn't have such an implement on hand and would probably have to use a sword or some other bladed weapon. (How well does a sword cut through flesh and bone? Will this even work? I mean, I assume it can be done, but it will be messy. Would they have to...hack through his arm, rather than cut? Ugh.) I suppose they cauterize the wound afterward. Anyway, how long would that take to heal? What kind of risks would be involved...I'm assuming amputating a limb using a sword in the middle of the wilderness is a rather risky medical procedure, but I want specifics. What would the scarring be like? (Ugly, I assume?) I'm assuming a cauterized wound can still get infected...What if this happens? 

The guy has to survive it, mind you. He doesn't have to be close to functional for several weeks, but he does live. 

Secondly (not actually directly related to the amputation itself, but): How long will it take to learn to write/draw normally with your other hand after your dominant hand is gone? (I'm assuming drawing will take longer, since it is seemingly more precise; but is this the case?) 

(Now heading into territory that might need some information from firsthand experience.) 

Now I'm thinking about how the character's life might change. This is something I've never thought about...always having taken having two arms for granted, I don't know anything about this experience. I do assume that walking will be a little difficult initially, due to being thrown off balance? Beyond that...how is said character going to learn to manage things like dressing himself? 

Even more difficult to grasp is how this would affect someone psychologically. I would hazard an assumption that losing a limb wouldn't be a purely physical injury. I mean, even outside of it altering your life forever, it's losing a part of *yourself.* That could have more than a physical/practical consequence for someone, couldn't it? 

This, again, is the core issue...I'll have to get firsthand testimony to capture the experience. Or spend a week or so with one of my arms tied behind my back...lol. I can just imagine the questions of my friends and family. "It's for research!" Still, being unable to use one's arm isn't the same as not having one...

Actually, trying to do different everyday things one-handed might be a good idea to get me just a little closer to the experience...is that ridiculous? 

Last question: Do all people who've had limbs amputated experience phantom pain? What does it even feel like? Is it at random times or does it have triggers? Is it actually that painful or closer to an annoyance?


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## Russ (Oct 28, 2016)

To give you a few starting points.  For a medieval, in the field, amputation I think the tool of choice would be an axe.  Very common and effective for this sort of thing. 

The types of injuries that might require an amputation are about as varied as your imagination.

The scarring can be very ugly, but the area can be debrided and trimmed by someone with the right skills.

Infections are all over the map as well.  Lots of variability to give you what you need.

Not all amputees suffer from phantom limb pain.


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## DragonOfTheAerie (Oct 28, 2016)

Russ said:


> To give you a few starting points.  For a medieval, in the field, amputation I think the tool of choice would be an axe.  Very common and effective for this sort of thing.



That was my initial thought, but I don't know if the characters will have an axe on hand. My idea was that they don't have anything ideal but they have to do it so they use most likely a sword. I don't yet fully know the circumstances surrounding it, though.


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## Russ (Oct 28, 2016)

DragonOfTheAerie said:


> That was my initial thought, but I don't know if the characters will have an axe on hand. My idea was that they don't have anything idea but they have to do it so they use most likely a sword. I don't yet fully know the circumstances surrounding it, though.




If you are stuck with a sword, there are plenty that could do the job.


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## skip.knox (Oct 28, 2016)

There are plenty of personal accounts about living as an amputee. If you can endure the reading, you may find good insight there.

Activities to consider: ride a horse, care for that horse, get dressed (buckles? ties? hooks? laces?), prepare food and eat it, personal hygiene, fight. 

Then there are the activities associated with the individual's profession. You mention write and draw, so I presume the character is literate. You could do both activities yourself. It can be done; just takes time. Your handwriting won't look the same, so good luck if a signature has to be verified. I can't draw with either hand; I'm ambi-useless in that respect, but try it yourself. But what other activities are associated with how your character makes a living? Being a one-armed thief could be a real challenge. I do know that there were no one-armed knights; at least, none that made it through combat. A knight does not, of course, lose his title because of an amputation. OTOH, there was famously John of Bohemia who went into battle blind. Alas, it was the battle of Crecy and he got his fool self killed.


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## DragonOfTheAerie (Oct 28, 2016)

skip.knox said:


> There are plenty of personal accounts about living as an amputee. If you can endure the reading, you may find good insight there.
> 
> Activities to consider: ride a horse, care for that horse, get dressed (buckles? ties? hooks? laces?), prepare food and eat it, personal hygiene, fight.
> 
> Then there are the activities associated with the individual's profession. You mention write and draw, so I presume the character is literate. You could do both activities yourself. It can be done; just takes time. Your handwriting won't look the same, so good luck if a signature has to be verified. I can't draw with either hand; I'm ambi-useless in that respect, but try it yourself. But what other activities are associated with how your character makes a living? Being a one-armed thief could be a real challenge. I do know that there were no one-armed knights; at least, none that made it through combat. A knight does not, of course, lose his title because of an amputation. OTOH, there was famously John of Bohemia who went into battle blind. Alas, it was the battle of Crecy and he got his fool self killed.



Ambi-useless. Lol! 

This character isnt a warrior necessarily, though he can and does fight. He has to fight his way out of some situations, but he is not a warrior by profession. He was, before the injury, a pretty good fighter (with a variety of weapons or just bare fists, whatever he had). 

The funny thing is, I'm not completely sure about his profession/role at this point...or at least I'm not sure of everything it entails. Parts of the plot are so murky. But it's likely that the amputation was necessitated by a battle injury in the first place. 

He's an artist, though, so that's why the learning to draw is important. I don't even know if he can write.


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## DragonOfTheAerie (Oct 28, 2016)

But, despite all I don't know I'll still have him doing everything in everyday life, such as the things you mentioned. 

Since this is so far down the road I'm not completely sure of a lot of the details about his life before the amputation, so my ability to discuss how his life might change is rather limited. It is a very important part of the story, at any rate. I know his role in the story approximately, but I don't know what that role might require him to do.


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## DragonOfTheAerie (Oct 31, 2016)

Umm...anyone else?


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## SerpentSun (Jan 9, 2017)

I think our ancestors had A LOT of good medical knowledge that the modern industry has lost or hidden. Not just the medieval days either, I mean the ancient prehistoric tribes. Look at how healthy wild animals are. They must have some medical secrets, and humans used to be wild animals too.

This topic greatly interests me. A character of mine also loses an arm at the shoulder, but he has the advantage of being ambidextrous and masochistic. I imagine it would still suck to lose an arm though.

My writing is bursting with bloody survival scenes. I enjoy realism, amputation included. Anatomy, biochemistry, ethnobotany, and history have been lifelong passions since elementary school. I might be able to help you with the medical aspect if I had more details.

But not yet haha, bedtime in my timezone.


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## CupofJoe (Jan 10, 2017)

I am lucky that I have a museum of Army Medicine fairly close by. Places like that can be a fount of knowledge and knowledge able people. I have asked a few questions and always found them helpful.
Unfortunate in the UK [and US I guess] we have a surfeit of traumatic amputees. There are rehabilitation charities and schemes all around me [but again I live in a military area], Those organisations are always strapped for cash and welcome volunteers.


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## SerpentSun (Jan 10, 2017)

I will say that cauterization actually increases the risk of infection. Burning would cause extra tissue damage, and it doesn't usually stop the bleeding as well as you'd think. Cauterization leads to amputation if there is something left to amputate.

In an ideal situation, wounds should be left open. Closing a wound can trap in infection, whereas leaving it open facilitates air flow and easier cleaning. All forms of wound closure cause extra tissue damage, whether it be cautery, sutures, or toxic wound sealant. But if the bleeding is bad enough, you have to do something.

I recommend stitching him up instead. It results in the least additional tissue damage, thus the least pain, scarring, or risk of infection. Unless you'd rather put him through more misery. And if the cut is made right, skin can be folded over the stump to better seal it.

Yes, they had the skill and resources to stitch wounds back then. Although a more specific time and place would allow me to suggest more specific tools and materials. Some basic rules apply though, if there is the time and will to stitch the wound. Number 1: Keep everything clean!

The "dirty" forest provides many antiseptic plants. If your story takes place before modern medicine, I suggest you study up. The surgical instruments can be sterilized by pungent herbal ungents or just plain fire. Sewing needles, bone saw, battle axe, etc, anything metal can be burned clean. Use antiseptics and clear water to wash the wound.

A suture needle should be smooth and curved, preferably as thin as is practical. The thread should also be smooth and thin, but strong enough to flex with the body. Whatever irritates skin the least is the best.

The thread should also be nonporous or waxed. This prevents moisture from being wicked down into the wound, which can lead to irritation and infection. Modern suture thread is often plastic, which has a composition somewhat similar to wax, and many nonporous natural fibers contain waxes. These waxes can also have antiseptic or skin-nutritive properties.

You could have a medieval shaman-type field medic character, have he/she carry a  surgical kit with a bone saw and suture thread. Saws have been around for a long time, and nature provides much good cordage fiber. Hemp, spider silk, sinew, etc. Just keep it smooth and clean.

You can even wax the thread yourself. Soak thin hemp cord in a blend of melted beeswax, shea butter, and grapeseed oil, with a little mint and clove to kill germs. The excess should be wrung from the thread before it cools. This blend would repel bugs and water, slide through skin smoothly, and provide vitamin E to help heal.

Sorry if this is too much information!


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## DragonOfTheAerie (Jan 10, 2017)

SerpentSun said:


> I will say that cauterization actually increases the risk of infection. Burning would cause extra tissue damage, and it doesn't usually stop the bleeding as well as you'd think. Cauterization leads to amputation if there is something left to amputate.
> 
> In an ideal situation, wounds should be left open. Closing a wound can trap in infection, whereas leaving it open facilitates air flow and easier cleaning. All forms of wound closure cause extra tissue damage, whether it be cautery, sutures, or toxic wound sealant. But if the bleeding is bad enough, you have to do something.
> 
> ...



Oh, no, don't apologize, it's very helpful.

It's interesting information, but you're telling me the best possible circumstances. In a story, you don't *necessarily* want that. So I don't know if the amputation and healing process will be quite ideal. Likely it will be an emergency procedure in the middle of the wilderness without any of the right tools on hand, so...I might want it to be a miserable near death experience  It's still very helpful though. Seriously. I'll save it.  

Cool to see that people have resurrected my dead thread  

In my graphic novel I have another amputee character in a modern setting. Geez.


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## SerpentSun (Jan 10, 2017)

DragonOfTheAerie said:


> Oh, no, don't apologize, it's very helpful.
> 
> It's interesting information, but you're telling me the best possible circumstances. In a story, you don't *necessarily* want that. So I don't know if the amputation and healing process will be quite ideal. Likely it will be an emergency procedure in the middle of the wilderness without any of the right tools on hand, so...I might want it to be a miserable near death experience  It's still very helpful though. Seriously. I'll save it.
> 
> ...



I would stitch wounds in real life, but I would probably go for cautery in my writing. There's just something about a hot guy screaming as he burns....But it really is better for plot purposes, more physically and mentally scarring. Burns seem worse than anything else for most people.

A cauterized wound will take longer to heal. Just a second-degree burn that size could take a month or more to heal, not including the damage from the amputation itself. Infection and shock are both serious possibilities.

Actually, hypovolemic shock is more of a probability than a possibility. A severed brachial artery can kill within minutes, and the closer to the torso, the greater the risk of exsanguination. It'll be an agonizing near-death experience regardless of how you close the wound.

Will he lose his arm right at the shoulder joint, or will there be any stump left? My character gets his ripped out of socket by a giant squid.  He thought they killed the only one out at sea, but that was just the baby. Momma Squid got angry.


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## DragonOfTheAerie (Jan 10, 2017)

SerpentSun said:


> I would stitch wounds in real life, but I would probably go for cautery in my writing. There's just something about a hot guy screaming as he burns....But it really is better for plot purposes, more physically and mentally scarring. Burns seem worse than anything else for most people.
> 
> A cauterized wound will take longer to heal. Just a second-degree burn that size could take a month or more to heal, not including the damage from the amputation itself. Infection and shock are both serious possibilities.
> 
> ...



Um, yeah, I want it to be an extremely intense and harrowing scene (it's from the patients's POV). Definitely. 

I think he blacks out partway through the procedure, so we might not get the hot-guy-screaming-as-he-burns. Lol. (I'm more fond of hot guy whimpering and wincing as his minor injuries get patched up after a battle. Culminating in his medic slightly sarcastically telling him he was very brave.) Then he spends days in fevered limbo as infection sets in. He probably would die if not for my character with healing powers (who can, albeit slowly, accelerate the healing process...her powers are nothing dramatic, though. She is his love interest so that's romantic I s'pose. No better way to make your characters bond than a horrifying, traumatic near death experience. Or two. Or three.) 

Arms ripped out of sockets by squid are cool. (Poor diction? Lol...) That sounds awfully painful, judging by how painful a mere dislocation is...And I don't know. Probably nothing left at all. I'm not quite sure how he gets the injury that necessitates the amputation, but I want some pretty ugly scarring...


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## DragonOfTheAerie (Jan 11, 2017)

...and I just had a character lose her fingers to torture, so...

...I'm really bad about mutilating.


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## Caged Maiden (Jan 11, 2017)

amputations in Medieval settings were common, and skilled "surgeons" were paid well. I read one account in a history book where a king needed a leg amputated because of an infection and he paid in gold to have the best guy do it because he could remove a leg in 18 second. They used a little saw. 

I can write well left-handed and have never really tried to do it. I'm sort of ambidextrous, though, and think it would only take a couple weeks to get proficient. So, maybe consider whether your character has some background scenarios where he might have fine motor skills with both hands?

I've never really heard of an amputation at the shoulder, and I'd think it would be very tricky because of all the blood vessels and nerves in that particular joint. Sawing through an arm or leg is easier, I suppose because there is no joint. 

Infection is usually what killed people. Depending on your culture, you could use treatments of honey (which has antibiotic properties), or herbs like sage and others (that also are antibiotic and anti-fungal), or things like opium, which has been used for thousands of years as a painkiller. or maggots, to keep infection at bay.


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## DragonOfTheAerie (Jan 12, 2017)

Caged Maiden said:


> amputations in Medieval settings were common, and skilled "surgeons" were paid well. I read one account in a history book where a king needed a leg amputated because of an infection and he paid in gold to have the best guy do it because he could remove a leg in 18 second. They used a little saw.
> 
> I can write well left-handed and have never really tried to do it. I'm sort of ambidextrous, though, and think it would only take a couple weeks to get proficient. So, maybe consider whether your character has some background scenarios where he might have fine motor skills with both hands?
> 
> ...



Maggots??...


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## Caged Maiden (Jan 13, 2017)

I think it came from the Middle East, but if you put maggots into a wound, they only eat dead flesh and leave healthy tissues alone. They still do it because it's the best way to target only infected flesh. You can apply the maggots, and they'll eat away the dead tissues in a wound, leaving it clean and able to heal.


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## DragonOfTheAerie (Jan 13, 2017)

Caged Maiden said:


> I think it came from the Middle East, but if you put maggots into a wound, they only eat dead flesh and leave healthy tissues alone. They still do it because it's the best way to target only infected flesh. You can apply the maggots, and they'll eat away the dead tissues in a wound, leaving it clean and able to heal.



Oh, that's cool.


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## kdl121 (Mar 26, 2017)

I'm sorry, I haven't read everyone's tips and suggestions, but I just wanted to share my experience with my amputation (which isn't much, it's not a whole arm!)

When I was 13 (I'm now 23), I had an incident while tubing. My dad would start the boat, and I would fall out of the tube because for some reason I couldn't get a grip. So I thought, why not wrap the rope around my hand ... not a smart idea. I ripped off my right index nail (it grew back), I bruised my right pinky nail, and I tore off a lot of skin on my right ring finger. My dad didn't think it was too bad at first, just go home and bandage it, but when we got back to shore the guy said a hospital visit wouldn't hurt ... thankfully he was right! So much skin was lost the doctors had to saw off part of the bone in order to attach the skin together. Fortunately the incident wasn't more serious, I have adapted to life without a fingertip (I know, that sounds weird to say) ... unfortunately, this incident meant I couldn't use my dominant hand for three weeks. At the time I was young and scared, so I started trying to write with my left hand ... I never became ambidextrous, but I got better by the end of that three weeks and it was almost legible. After the bandages came off, there was still issues. I have nerve damage in that finger, so when it's cold out that finger feels it more than any other part of my body, to the point where it feels like it's burning. It's also super sensitive when I bang it on something, so I try to be more careful around it now ... but I still remember just a few months after the incident, I tapped it (yes, a gentle TAP, that was it) on a chair and it throbbed for two minutes. I did have phantom limb pain, but I don't remember how long it lasted, I don't think I've felt it for quite awhile. And happily, I'm able to type with the finger without feeling pain! (Although I definitely make more mistakes than I used it ...)

In terms of aesthetics, no one ever notices it unless I point it out to people (most people don't look at other people's hands), but it's now shorter than my other ring finger and it's puffed out (especially at the tip).


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## Russ (Mar 28, 2017)

Great article in the jan/feb 2017 issue of Medieval Warfare about a guy named Gotz who had his right hand amputated after a really bad wound.  He was about 25 at the time and eventually learned to fight with his left.  The article has great detail on the weight and design of his prothesis etc, I highly recommend it if you are serious about this issue.

Apparently the amputation left this very tough son of a gun in bed for about 7 months (from July to next Feb).


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## elemtilas (Apr 14, 2017)

DragonOfTheAerie said:


> Oh, that's cool.



Yeah, maggots are fun! They do a good job of it, too, but you do have to pick em off the wound once they've finished dining. Just apply fresh ones as needed!

Some things to consider:

As for amputation at the shoulder, I would suspect a devastating wound -- a crushing blow of some kind -- along the upper arm with no means of fixing it any other way. The muscle is badly damaged and the bone is fragmented. A good recipe for embolism which is very dangerous.

If the whole arm is removed, right up to the joint, that's technically a disarticulation. Just pull the whole thing right off. A cut any lower will be an amputation. An axe or hatchet would work, but then the operation is every bit as savage a butchery as the initial wound. A disarticulation could be done with a dagger or small knife, in the absence of a surgeon, because all you're really doing is yanking on what's left of the arm and slicing through all the tendons and cartilage around the shoulder joint. No bone work means no saw (or sword) required. Honestly, knives and swords don't do very well when cutting through bone anyway; and a sword would be overkill for the job of disarticulation, especially when you've got any number of knives and daggers right to hand.

Just take care to leave enough muscle to shove up into the joint (provides padding) and skin (to cover the wound). Apply hot irons (or whatever tool you have handy) to cauterize the vessels, lay the skin flap over the wound and bind him up securely until he can be evacuated to whatever passes for skilled medical treatment in this setting! If it's anything like medieval era care, he'll have a good chance of dying from the doctor's care and the infections he'll bring along to the case more than from the wound itself.


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## ALB2012 (May 13, 2017)

Agreed with most of above posts - IF the subject didn't bleed out or die of shock infection would be the likely killer. It wasn't certain - people did live with the loss of limbs - but would be pretty likely.  If your team has alcohol - that can be used to clean (if it's a spirit), or to knock out the patient. After all the subject probably doesn't want to be awake, and those carrying out the proceedure don't want some wriggling, screaming patient.

Yes there would be psychological wounds


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## Rkcapps (May 14, 2017)

I can speak from the experience of losing the ability to lose the ability to use my right arm (I was right handed before) but by a stroke. An OT told me it takes years to relearn writing. When I stand my right arm hangs so my core muscles have to turn on to stop my body twisting. This may or may not apply to an amputee. I'm slowly learning to do more with my left hand but a stroke is very different to an amputee. With an amputee, their body still receives brain signals.

The psychological damage would be something you can imagine. If you had a limb one day and it was gone the next, how would you feel? Initially, you may fret for your health. How would your self image be? There are moments of pure frustration to explore, maybe just drinking is hard with a non-dominant hand? There will be moments of wishing for a life before the amputation. Is your character so affected it makes life crush them?

I definitely heard amputees complaining of phantom pain but someone mentioned looking at literature. That's a great idea.

They call the amputated site a stump and bandages need regular changing. There is a certain pressure required for bandages. Google it.

There is a lot to consider. Knowledge will lend you depth. Good luck!


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