context: Amputation is the surgical removal of all or part of a limb or extremity such as an arm, leg, foot, hand, toe, or finger. About 1.8 million Americans are living with amputations. Amputation of the leg -- either above or below the knee -- is the most common amputation surgery. There are many reasons an amputation may be necessary. The most common is poor circulation because of damage or narrowing of the arteries, called peripheral arterial disease. Without adequate blood flow, the body's cells cannot get oxygen and nutrients they need from the bloodstream. As a result, the affected tissue begins to die and infection may set in. Other causes for amputation may include: Severe injury (from a vehicle accident or serious burn, for example) Cancerous tumor in the bone or muscle of the limb Serious infection that does not get better with antibiotics or other treatment Thickening of nerve tissue, called a neuroma Frostbite An amputation usually requires a hospital stay of five to 14 days or more, depending on the surgery and complications. The procedure itself may vary, depending on the limb or extremity being amputated and the patient's general health. Amputation may be done under general anesthesia (meaning the patient is asleep) or with spinal anesthesia, which numbs the body from the waist down. When performing an amputation, the surgeon removes all damaged tissue while leaving as much healthy tissue as possible. A doctor may use several methods to determine where to cut and how much tissue to remove. These include: Checking for a pulse close to where the surgeon is planning to cut Comparing skin temperatures of the affected limb with those of a healthy limb Looking for areas of reddened skin Checking to see if the skin near the site where the surgeon is planning to cut is still sensitive to touch During the procedure itself, the surgeon will: Remove the diseased tissue and any crushed bone Smooth uneven areas of bone Seal off blood vessels and nerves Cut and shape muscles so that the stump, or end of the limb, will be able to have an artificial limb (prosthesis) attached to it The surgeon may choose to close the wound right away by sewing the skin flaps (called a closed amputation). Or the surgeon may leave the site open for several days in case there's a need to remove additional tissue. The surgical team then places a sterile dressing on the wound and may place a stocking over the stump to hold drainage tubes or bandages. The doctor may place the limb in traction, in which a device holds it in position, or may use a splint. Recovery from amputation depends on the type of procedure and anesthesia used. In the hospital, the staff changes the dressings on the wound or teaches the patient to change them. The doctor monitors wound healing and any conditions that might interfere with healing, such as diabetes or hardening of the arteries. The doctor prescribes medications to ease pain and help prevent infection. If the patient has problems with phantom pain (a sense of pain in the amputated limb) or grief over the lost limb, the doctor will prescribe medication and/or counseling, as necessary. Physical therapy, beginning with gentle, stretching exercises, often begins soon after surgery. Practice with the artificial limb may begin as soon as 10 to 14 days after surgery. Ideally, the wound should fully heal in about four to eight weeks. But the physical and emotional adjustment to losing a limb can be a long process. Long-term recovery and rehabilitation will include: Exercises to improve muscle strength and control Activities to help restore the ability to carry out daily activities and promote independence Use of artificial limbs and assistive devices Emotional support, including counseling, to help with grief over the loss of the limb and adjustment to the new body image