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James simpson
11-27-2013, 08:18 PM
I have seen some related threads but none quite cover what i'm looking for. One of my characters needs to have her arm amputated. (As you would expect from a zombie book it's a zombie bite) She is the doctor and the only one with professional knowledge on how to do it, so she is quickly talking someone through it. Surgical materials aren't too much of a problem, they're in a hospital when it happens anyway.

The cut will be through the bicep/triceps and the humerus in approximately the middle. What I'm thinking is a tourniquet bellow and above the cut.

What I need to know is whats the best way to do it? In a straight line or with skin/muscle flaps? How will he block off the arteries? Whats the best way to seal the wound? (I've already eliminated cauterizing thanks to another thread :) ) And what lasting side effects will there be?

Thanks for the help :)

MagicWriter
11-28-2013, 10:38 AM
Is the scene really about severing the arm here? Physically, it may be, but it doesn't have to be, to move the story. This could be a good spot to get into a character especially since not just anyone could instruct another person to perform an amputation, and not just anyone would be able to perform said amputation.

You can see a close example in GRRM's Game of Thrones, season 2 when Rob assists the field nurse (i forget her name), as she amputates a soldier's foot after a battle. The scene is really about Rob learning who this girl is, not so much about the amputation.

Just IMHO. Good luck with the story.

James simpson
11-28-2013, 07:36 PM
I have seen that and I do know what you mean. The scene is to explore her character a little more, show a more stubborn/resourceful side that we haven't seen yet and to lightly screw/traumatize the man performing the amputation.

I'm a stickler for the truth though. I want it to be as close to 'real life' as possible, hence the desire for the gory details.

CoolBlue
11-28-2013, 09:14 PM
OK, I'll bite. Be warned that you will not likely get someone without surgical skills to perform an appropriate amputation that will not need revision. Note, I have never done an amputation myself. Assisted with a few, though.

Think structurally, then principles.

Skin and subcutaneous tissue: The final incision needs to be neat, and preferably not at the end of the stump, but to the side. There should be no "dog ears". This is not as easy as it sounds. A plumber who knows how to join pipes at strange angles will know what is involved. Hint.

Muscle: There are 3 muscles. Brachialis, Biceps, with 2 bellies, and triceps, with 3. The muscle needs to cover the end of the bone without excess flabbines, to form a firm, yet supple stump. Experience with the healing process helps judgement here.

Arteries, veins: Depending on exactly where you amputate, there will be several. The main principle is to identify, tie off, then sever all the main vessels. Also veins. You will exsanguinate quickly from an uncontrolled brachial artery hemorrhage. The walls will be covered in blood. 120 mmHg is a lot of pressure. Do not underestimate it. You will not need a tourniquet below the incision. Depending on the level of desperation and skill of the, er, surgeon, you should not need one above either.

Nerves: There are 3 main ones. Radial, ulnar and median. These are often what cause the most problems after an amputation. They need to be indentified, and divided, preferably not at the same level, and certainly need to be well hidden in the depths of the wound. The problem is called a neuroma - an exquisitely sensitive masss of new nerve growth at the end where it was severed. Very difficult to deal with.

Bone: We need to start our thinking with the bone. Generally speaking, we want to preserve as much length as possible, with the proviso that we need sufficient muscle and skin to cover the stump as mentioned above. So, the muscles need to be pulled back, so that the bone can be cut. For this, you will need a saw. Then, when it is cut, the bone needs to be rasped smooth. Wax is rubbed into the marrow space, to seal it off. Then the bone needs to be carefully covered with muscle and skin.

When all is said and done, a drain will likely be needed, to let all the excess blood and serum drain out during the first few days of healing. Otherwise, you will have a nasty collection of fluid that could get infected.

Of course, you will need profound anesthesia.

Oy. Good luck!

CB

James simpson
11-28-2013, 10:12 PM
Thanks CB, that is very useful. I need to plan out this operation very carefully.

The lower tourniquet had nothing to do with the amputation itself but to stop the spread of the infection to the rest of her body while she explains it. (Like i said, zombie bite.)

I had't considered the nerve aspect of it, I have a feeling that she will end up with a neuroma. :P

CoolBlue
11-29-2013, 11:26 PM
The lower tourniquet had nothing to do with the amputation itself but to stop the spread of the infection to the rest of her body while she explains it. (Like i said, zombie bite.)


Yeah. :D

I reckon I missed the class on zombie infestations. Thought it would not be useful.

Silly me. ;)

CB