A double amputee is a person who has undergone the surgical or traumatic loss of two limbs. The medical term for this condition is bilateral amputation, signifying that two of the body’s four extremities—the arms or legs—have been removed or are missing. This condition can involve both upper limbs, both lower limbs, or a combination of one upper and one lower limb. This permanent condition results from a variety of medical or accidental circumstances.
The Medical Definition and Classification of Dual Amputations
The clinical designation for a person with two missing limbs is a bilateral amputee, a term that emphasizes the involvement of both sides of the body. Classification of a bilateral amputation is highly detailed, depending on which limbs are affected and the level at which the removal occurred. A person may have a bilateral lower limb amputation, meaning both legs are involved, or a bilateral upper limb amputation, affecting both arms.
The specific terminology used is based on the remaining bones and joints, which dictates future prosthetic requirements and rehabilitation planning. In the lower extremities, the most common levels are transtibial (below the knee, or below-knee amputation) and transfemoral (above the knee joint, or above-knee amputation).
Similarly, upper limb amputations are classified by their relation to the elbow joint. A transradial amputation occurs below the elbow, preserving the elbow joint’s function, and is known as a below-elbow amputation. Conversely, a transhumeral amputation is performed above the elbow, resulting in the loss of the elbow joint, and is called an above-elbow amputation. Amputations can also occur directly through a joint, such as knee or wrist disarticulation, where the bone is not cut.
Underlying Causes of Double Limb Loss
The reasons a person may experience bilateral limb loss fall into several distinct categories, with disease being the most frequent cause in non-traumatic cases. Vascular disease, which affects blood flow, is responsible for over half of all surgical amputations. This condition is most often a complication of unmanaged Type 1 or Type 2 diabetes, which damages blood vessels and nerves over time.
Peripheral Artery Disease (PAD) is a common manifestation, where fatty deposits restrict blood supply to the lower extremities, leading to tissue death, or gangrene, that necessitates surgical removal of the affected limbs. In these scenarios, the amputation of the second limb may occur years after the first, or both may be removed simultaneously due to widespread disease progression.
Traumatic injuries represent another major cause of bilateral limb loss, typically resulting from severe accidents. These can include combat injuries, motor vehicle collisions, or industrial machinery accidents that cause immediate, irreparable damage to two separate limbs.
Infection can also lead to bilateral amputation when a severe, uncontrolled systemic infection, like sepsis, causes widespread tissue necrosis that cannot be stopped by antibiotics. Finally, a small number of people are born with bilateral limb loss due to congenital limb deficiencies, a condition where the limbs failed to develop properly in utero. These cases are present from birth and are not the result of surgery or trauma.