Pathways to Amputation

Amputation as a result of trauma

Generally you will arrive at the hospital via an ambulance, so your first contact with the rehabilitation team will be the paramedics who treat you at the scene and en route to the hospital.

You will be taken to the Accident and Emergency Department for assessment.

In A&E you will see:An A/E Nurse, A/E Doctor, and then the appropriate specialist doctor.

Surgery

You will be treated by an anaesthetist, surgeon and the surgical team. For trauma you are usually treated by an orthopaedic surgeon, but if arteries are involved the vascular consultant is sometimes called to help.

Plastic surgeons are rarely involved in traumatic surgery; however this would be more usual for war injuries, such as landmine injuries and burns.

After surgery you will be looked after by the ward nurse. Sometimes you will be seen by a pain specialist, but if you need to go to surgery urgently the anaesthetist on call will look after your pain management.

Your post operative treatment will be the same whether you are a traumatic or non-traumatic amputee.

The biggest difference between traumatic and non-traumatic amputees is that in cases of traumatic amputation surgery is performed as a matter or urgency, and sometimes there is little time to prepare the patient mentally for the surgery, sometimes the patient is even unconscious and knows nothing of what is going on. This is also incredibly stressful for relatives who will be faced with the patient’s shock on coming  round from the anaesthetic to find that they have had an amputation.

Amputation as a result of a pre-existing condition

Your GP will make the original referral. This is normal his/her only involvement unless the patient goes to a Cottage Hospital for post-operative convalescence as a stepping stone and they are then responsible. (need more info).

The GP will refer you to a specialist. Whether this is a vascular or orthopaedic specialist will depend on the pre-existing condition.

It would usually be a vascular specialist as vascular related complications result in a high percentage of the amputations performed in the UK, but it would be an orthopaedic specialist if the amputation is due to an orthotic problem.

Prior to the amputation the patient will be fully counselled by the specialist with regard to the pros and cons of proceeding with the amputation and, where possible, alternative choices are given. 9 times out of 10 it is the patient’s choice to proceed with the amputation.

It is worth noting that, for vascular patients, pain is a major issue and can be a factor in the decision-making process. Once the decision to proceed with the amputation surgery is made a date will be set. There is not a waiting list for this. The patient will attend Hospital for the amputation.

‘Work Up’

The pain team will give the patient an epidural (they aim to do this 48hrs pre-op, as a measure of preventing phantom pain. The patient will see the physio, OT and specialist nurse pre-op and will receive advice. They can see a counsellor if they want to.

The patient is given the chance to ask questions. It is here that some hospital will inform patients about the opportunity to meet an established amputee, often called the ‘Buddy System’.