The MC2's Peter Parker doesn't get enough respect, love and understanding. For anyone who hasn't been through the life-altering experience of losing a limb, it's perhaps difficult to relate to and therefore harder to grasp just how significantly it impacts on a person's life. So, I'm going to attempt to do the subject justice today and break down some of the immediate, short-term and long-term effects of a traumatic amputation.
To begin with, lets review the events leading up to Peter's accident. Following the safe return of his infant daughter May by the murderous Kaine, Peter vows to track down and prevent the death of his arch enemy Norman Osborn aka The Green Goblin at Kaine's vengeful hands. Eventually locating Norman amid a strange ceremony, Peter interrupts as Spider-Man only to find himself in a fierce battle with his bitter enemy. Things turn dire when Norman grabs hold of Peter's right leg and threatens to set off one of his pumpkin bombs. Attempting to web the bomb to Norman's hand, Peter instead finds his leg and Norman's hand webbed together when the latter deflects the shot. Not missing his second shot, Peter manages to web the bomb to Norman's hand only for the madman to detonate it, killing himself and mutilating Peter in the process.
Peter's wife Mary Jane Watson-Parker receives the phone call from one of Peter's closest superhero friends, Johnny Storm of the Fantastic Four. When she arrives at the Baxter Building she learns from Reed Richards aka Mister Fantastic that despite the surgical team's best efforts, Peter's right leg could not be saved.
Here is where I think we should talk about some of the real-world physiological considerations of Peter's injury. The most apt classification for this type of bodily damage is traumatic amputation, such as the kind seen among those in combat or the victims of terror attacks, where the amputation does not occur as a result of chronic illness. Given the nature of the explosion, the best comparison for the mechanism of injury would be to a suicide bombing using a home-made explosive device as Norman Osborn did not survive his own attack.
Due to the complex physical nature of an explosion on the musculoskeletal system, including the blast wave, penetrating fragments and rapid bodily displacement, the injuries affect all tissues causing significant soft-tissue loss. For a person-operated Improvised Explosive Device (IED) explosion, the blast wave is transmitted directly into the victim's limb, causing a brisance or shattering effect on the bone. Within one to two milliseconds following the detonation, the detonated products, casing and environmental fragments hit the limb which causes the destruction of the traumatised soft tissue. This causes maximal stresses on the previously damaged bone affected by the shockwave. The result is either a total or subtotal amputation of the limb with extensive soft-tissue damage in addition to the significant amount of debris and fragments lodged within.
One of the immediate concerns following an injury caused by an explosion such as this is blood loss. Peter could very easily have died right there and then, bleeding out as he lay helpless and broken. Applying military combat-related priorities to this scenario, haemorrhaging becomes the primary concern, with the focus being on preventing significant blood loss. This approach takes priority over the standard Airway, Breathing and Circulation survey training associated with first aid and Cardiopulmonary Resuscitation (CPR). Whomever aided Peter in the initial moments after the explosion probably saved his life.
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| The zones of injury following a mine explosion. Source: Ramasamy et al. (2013) |
As mentioned above, Reed Richards was among the surgeons who performed the surgery. During emergency surgery debridement is carried out to excise necrotic tissue and foreign material such as energised explosive fragments. The surgical team would have also had to remove the critically damaged skin, tenons, muscles, bones and neurovascular structures which would have been partially severed beyond repair. As the image above illustrates, surgical amputations through Zone 1 are considered non-viable and -often as result of various micro-lacerations severing small and large blood vessels causing haemorrhages and a lack of reliable blood flow to sustain the affected area- parts of Zone 2 are also not salvageable.
Based on evidence from the comics themselves and by conferring with artist and co-creator Ron Frenz, it appears Peter's surgical amputation was at the transtibial or below-the-knee level. I am prepared to be corrected on this point, as there is an instance which could be interpreted as depicting a transfemoral or above-the-knee amputation. However, for the purposes of this discussion, I will adhere to the assumption it is a transtibial amputation. For the sake of transparency, here is the potential depiction of a transfemoral amputation:
While we don't know the details of the surgery performed, I believe given the evidence we can venture a guess that Reed Richards and his surgical team may have implemented osteomyoplastic transtibial amputation, better known as the 'Ertl procedure'. This involves forming a 'bony bridge’ between the end of the tibia and fibula, creating a better platform for weightbearing, restoring optimal circulation, muscle tension and improved stability for prosthesis management.
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| The 'bony bridge' formed using the Ertl procedure. |
Post-operatively, Peter would be at great risk of several complications including shock, compartment syndrome, deep vein thrombosis, pulmonary embolus, fat embolus, rhabdomyolysis and breakdown of the skin. Further to this, wound infection and especially osteomyelitis are significant potential complications. Should the surgical wound not heal appropriately due to dehiscence, or the stump fail to form in a manner conducive to the application of a prosthetic it means Peter would require further surgical interventions to correct or reconstruct.
Many amputees immediately following their operation demonstrate denial in the form of bravado and competitiveness, while others resort to humour as a way to minimise the effects and severity of their condition and appear euphoric, at times accompanied by an increase in motor activity and jokes. However, eventually the sadness will set in and the person will begin to experience true grief in response to their limb loss. This is a universal reaction, but one that does not last forever. There are four stages to this form of grief, similar to the loss of a loved one: 1) numbness, in which outside stimuli is shut out or denied; 2) pining for what is lost; 3) disorganization, in which any hope of recovering the lost part is abandoned and finally; 4) reorganization. Everyone experiences this differently and it varies from person to person in terms of length, often lasting well beyond their in-hospital rehabilitation.
Peter is going to be experiencing some pretty major pain. The most well-known type is ‘phantom limb pain’ which occurs after both the traumatic and surgical amputation of a limb. It’s reported by sufferers that it can occur anytime after the incident, with some people experiencing it within 7 days of their operation, while for others the pain doesn’t occur for several months. This pain can manifest as a burning, cramping, tingling or electric shock sensation and is reported by up to 85% of amputees. Treating phantom limb pain is notoriously difficult, because it often doesn’t respond to standard analgesia nor neuropathic pain medications Often phantom limb pain is persistent and relentless, but can be difficult for the sufferer to differentiate from phantom limb sensation and pain located in the stump. It’s thought that this ongoing pain may be as a result of the surgery and trauma damaging peripheral nerves causing spontaneous activity at the site of the injury and consequently the transmission of pain signals which can in turn trigger ‘pain memories’ in the brain.
This type of intractable pain can affect every aspect of the sufferer’s life including spousal relationships, sleep patterns, family relationships and professional duties. Peter may even struggle with his own sanity, as it’s difficult for the human mind to comprehend and process pain in a part of the body that is now absent. This could further compound Peter’s psychosocial state leading to depression, anxiety and catastrophic self-harming or damaging attitudes and behaviours. Contributing to all this will be the fundamental changes in Peter’s body image which will be discussed a little further down.
Another priority for Peter would be commencement of physiotherapy, as this forms a major part of the rehabilitation process. Part of the importance of this is to strengthen or maintain muscle mass and prevent contractures, while also encouraging blood flow and movement in the remaining limb and promote mobility and independence. The exercise routine includes quadriceps, leg raises, inner range quads, hip adduction with resistance, outer range quadriceps, static gluteal contractions, hip flexor stretch, bridging, hip flexion and extension while laying on side, hip abduction while laying on side and knee flexion while prone. Peter will have to learn to sit with his residual leg extended, as now simply sitting with it bent could compromise the blood supply to the area and increase potential contractures.
Most importantly, Peter would now have to learn to walk again, this time with a prosthetic. The sooner Peter begins active exercises and resumes mobility again, the better the overall recovery outcome. Even after the external wounds has healed, there is still a long process of rehabilitation. Peter may require extra padding while his internal tissues and bone heal fully. As this continues, Peter will have to attend therapy to improve his range of motion, keep his joints limber, prevent atrophy and minimize scar tissue.
Learning to walk with a prosthesis means Peter has to train his body in a new skill, something that can take several months and will require expert assistance from a physical therapist. To begin with, Peter will have to be fitted with an appropriate prosthesis designed for his specific level of amputation, one with a comfortable fitting socket. With the physical therapist, Peter will slowly regain some of his strength, flexibility and confidence while using the prosthesis. Starting with the use of parallel bars, Peter will learn how to transfer some of his weight onto the prosthesis. Humans naturally shift weight across our body as we walk, and learning to put full weight onto a prosthesis will walking is difficult to master. Over time, Peter will transition from both arms on the parallel bars for support to using only one arm while walking to eventually walking comfortably without upper body support. Attempting to rush the process without the use of mobility aids can easily lead to injuries. Even after mastering walking, it’s advisable for Peter to take things slow especially when faced with challenges such as stairs, curbs, hills or uneven surfaces. Peter will also need to utilize advanced exercises to improve his confidence, such as balancing on one leg, bouncing a ball will standing or walking and more practical exercises such as walking on various surfaces, falling and getting up, getting in and out of cars and carrying items while walking. This process is slow and will lead to muscle soreness as the body adapts to a new way of walking.
It’s vitally important that Peter learn appropriate stump care techniques so as to avoid small problems developing into serious issues that are difficult to treat. While his surgical wounds healed, Peter would have been taught the correct method of applying bandages to his stump to avoid swelling, aid healing and help form a suitable shape for his prosthesis. Afterwards, as part of his daily care routine, Peter must wash his stump at least daily in the evening with warm water and mild soap before drying it thoroughly and carefully, avoid soaking in a bath as this will soften the skin on the stump leaving it prone to injury. He’s also going to apply talcum powder to help absorb perspiration and avoid the use of methylated or surgical spirits which reduce natural body oils protecting the skin. Pete’s going to need to regularly perform skin inspections; monitoring for friction and stresses on his skin and stay vigilant for bacterial infections from trapped sweat in the prosthetic socket.
Two thirds of amputees’ manifest psychiatric symptoms including depression, anxiety, spells of crying, insomnia, loss of appetite and suicidal ideation. It’s unclear if Peter actually received any formal counselling due to his secret identity, but given that he presents as an amputee in his civilian identity it does raise the question of what the general public believes about the cause of his injury. From a psychosocial perspective, Peter would need counselling, education and support to help adjust to life as an amputee. Depression is extremely common, being often reported as a reason for a patient’s decreased prosthesis use and a lower level of mobility. I think it’s likely Peter himself suffered or continues to suffer from depression to some extent as several studies indicate it remains prominent even 10 to 20 years post-amputation. Depression itself would exert further negative effects on Peter as he recovered including a loss of energy, pessimism, anger and as a result a further delay in his rehabilitation which would also further contribute to his depression.
Peter also likely suffered from body image anxiety at first, struggling to reconcile his previous view of himself, his desirability, his physical appearance, his ability to provide and care for others with how he looks following the lose of his lower limb. Some amputees have extreme difficulty coming to terms with their changed appearance, considering their appearance unacceptable or disfigured, while others report dreaming of themselves with limbs fully intact only to wake and be distressed by their changed condition again. This is understandable when considering that an amputee such as Peter has to reconcile three body images: himself intact, amputated and with a prosthesis. An indicator that a person has fully accepted their amputation is the presence of their prosthesis within their dreams. Luckily, many young adults around Peter’s age at the time have the advantage of having an established identity, social confidence and support network and thus tend to adapt well to the change. In Peter’s case, he has the love and support of his wife Mary Jane to help make the transition easier by assuming functions as needed and cutting back on assistance to allow Peter to maintain his self-esteem.
While each person is affected differently, some amputees experience significant change in their temperament, usually attributed to a fear of dependency on their loved ones, changes in occupation and ability to perform and disruption to both family and social life. An attitude of defiance to overcome problems, an acceptance of their situation and a desire to seek out alternatives to compensate for these perceived shortcomings as well as aggression and a grudge against society for treating them unfairly are also possible. Peter certainly demonstrates many of these characteristics, but also appears to have mostly come to terms with his disability. We see various changes in Peter’s temperament in his interactions with his teenage daughter Mayday, where he often struggles to maintain his composure and can become irritable about small matters. His ongoing struggles with dependency and self-esteem are evident in stories where we see him desire to return to his super heroic identity only to soon realize he is either no longer fully capable of doing so or that his daughter Mayday has assumed the role and responsibilities of a hero in his stead.
An oft cited indication that a person is adjusting well to their changed situation is a return to the workforce, to the point that this is considered an integral part of a patient’s recovery. Depending on the person’s amputation and level of ability and mobility it can be difficult or impossible to return to their previous vocation. Many amputees view unemployment as a denial of their right to participate in family decision making processes. However, successful rehabilitation should be measured on a person’s ability to resume active decision-making about their lifestyle which is fulfilling. We know that Peter abandoned his super hero identity for various reasons, stating that his family was more important, and having previously landed a job as a forensic scientist with the New York Police Department he likely no longer worked as a freelance photographer for the Daily Bugle. That said, adjusting to his new level of ability would have proven difficult, with many emotionally challenging moments and even discriminatory practices ranging from subtle or explicit still being present in the modern workplace, regardless of laws prohibiting such acts. Workplace psychological stress and fear of unemployment can contribute greatly to the presence of phantom pain. Thankfully for Peter, he found renewed purpose and remains a respected member of his precinct, contributing to the prosecution of long-time crime lords such as Wilson Fisk aka The Kingpin and even receiving a special commendation recognizing his efforts. This type of long-standing permanent employment undoubtedly contributes to raising Peter’s self-esteem and helps him reconcile his perceived shortcomings with his sense of responsibility. I’m certain his Uncle Ben would be proud of the man he became.
I think it’s clear that despite hanging up his webs and returning to a more normal civilian life, Peter’s daily activities are still fraught with danger and acts of bravery as he continues to uphold his values and responsibilities in both his work and home life. Naturally, Peter is something of a changed man after losing his lower leg. He’s suffered some post-traumatic stress, had to learn to walk again, adapted to a lowered level of mobility and ability and changes in his self-image, battled depression and anxiety and low self-esteem, suffered humiliating accidents and violent assaults which target his prosthesis and leave him unable to walk without assistance; all while holding down a full-time job and maintaining his responsibilities as a husband and father.
I wasn’t sure how much information to include in this post, so I may have over explained in some areas or left out too many details in others. At its core, I wanted this post to educate and inform people about the very real struggles and difficulties faced by many people who’ve had an amputation, while relating it to a character I have the utmost respect and admiration for and who I believe doesn’t get enough credit or love amongst fans. I also wanted a good reason to apply some of my professional knowledge with my favourite hobby. This post took way too long to research, way too long to write and way too much time to rewrite due to lost saved data. Let me know if there’s any thing I could have done better and if you have any questions feel free to ask. A huge thanks to my fellow medical professionals for all their hard work and hard data, my partner for putting up with my obsessiveness and to arias-98105 for tracking down so many images.
Until I find a quicker and easier way to express myself, I remain
frogoat