A central resource for individuals with congenital or aquired limb loss, their families, carers and healthcare professionals
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The Amputation Process

WHAT HAPPENS DURING AMPUTATION

You will arrive at surgery through one of the two paths discussed previously.

The aim of surgery is to fashion a residual limb (stump) of optimum length and shape to aid prosthetic use.

The main techniques are:

  • Optimum length
  • Myoplasty (muscles anchored to opposing muscles.)– Myodesis
  • Skin Cover

Particularly in diabetics, the disease process may be limited to one or several toes and a limited procedure to remove these toes may be successful. However, it is more likely that the foot or even the entire lower leg may be involved thus necessitating a more major operation. Amputation of the leg is commonly performed at one of two sites just above the knee or just below the knee. These sites are selected because of their suitability for fitting an artificial leg when the wound is healed. Where possible, the knee joint is preserved by performing a below knee amputation.

POSSIBLE COMPLICATIONS OF AMPUTATION

As with all other procedures in vascular surgery you will tend to be older than average and are more likely to have been a smoker. In that case you may therefore be prone to chest and heart problems after an anaesthetic. The usual complications of any surgical procedure, such as blood clots and infection, also apply. There is little that you can do yourself to reduce this risk. Of particular importance following amputation is wound healing. This may be delayed by infection or poor circulation at the level of amputation. If you have diabetes, your doctor will try and ensure that your blood sugar control is as good as possible. This will help the healing process. Because of the desire to maintain the knee joint the surgeon will try to do a below knee amputation where possible. Occasionally this may mean that circulation is not good enough for the wound to heal and the amputation may need to be done again above the knee.

IF AMPUTATION IS NOT PERFORMED

With severe blood vessel disease, the probable deterioration means that a limb with bad pain is likely to get even worse. This means that, at best, the pain will increase. The next step is actual tissue death and then the development of infection, often known as gangrene. In many instances gangrene can be very dangerous as the infection can spread through the body and become life-threatening.

POST OPERATIVE CARE IS THE SAME FOR TRAUMATIC AND NON-TRAUMATIC AMPUTEES.

In straightforward cases, an amputation should heal within 2 weeks. As with any surgical wound, there will be a certain amount of pain. However, a unique feature following amputation is the common complaint of phantom pain. This may be more common if there was severe pain prior to amputation. It can be quite distressing to feel pain in the part of the leg which has actually been removed. It is a well recognised feature of amputation surgery and it is equally well recognized that it will eventually disappear. The usual painkillers will not help much with phantom pain but it will sometimes improve with a particular type of drug which numbs the nerves.

Once the wound has healed, measurements will be taken for an artificial leg (prosthesis) and the physiotherapists will be involved in your care. Their function is to improve your balance and to increase the power of the remaining muscles. It can be quite difficult for elderly patients to get used to an artificial leg. Certain patients may not be suitable even to attempt it. It is essential for you to have the firm resolve to walk again, because it can be very hard work. This can be made easier with the help of skilled physiotherapists and nursing staff who are used to caring for amputation patients.

Post amputation a referral will be made to a rehabilitation centre often referred to as a disablement service centre (DSC). A physiotherapist will generally refer upper limb amputees while occupational therapists usually refer lower limb amputees.

It is usually a matter of course for the patient to visit the rehab centre while they are still an in-patient in hospital; this is an opportunity for the patient to meet the rehabilitation team they are going to be working with.

If a patient has to care for a partner, parent or children or is having difficulty, a social worker may become involved in the process. Anyone can make a referral to social services as long as they have the patient’s consent.