Amputation

What is amputation?

Amputation is surgery to remove all or part of an arm or leg. It may be done to treat injury, disease, or infection. It may also be done to remove tumors from bones and muscles.

Why might I need an amputation?

The most common reason for amputation is poor blood flow. This happens when arteries become narrowed or damaged. When this occurs in the arms or legs, it’s called peripheral arterial disease or PAD. PAD most often occurs between the ages of 50 to 75. It usually results from diabetes or atherosclerosis. This is a buildup of plaque inside the artery wall. Poor blood flow causes infection and death of tissue.

Other reasons you might need this procedure include injury, such as severe burn or accident, or cancer in a limb.

Amputation may also be done for serious infections that don't respond to antibiotics or other treatment. In some cases, it may be done due to frostbite or neuroma. This is a thickening of nerve tissue.

There may be other reasons you may need an amputation.

What are the risks of amputation?

People with diabetes, heart disease, or infection have a higher risk of complications from amputation than others. Above-knee amputations are riskier than below-knee amputations.

Other complications may include:

• Joint deformity

• A bruised area with blood that collects underneath the skin (hematoma)

• Infection

• Wound opening

• Tissue death

• Blood clot in the deep veins in the limb or in the lung

You may have other risks, based on your condition. Talk with your surgeon about any concerns you have before your amputation.

How do I get ready for an amputation?

Ask your surgeon to tell you what you should do before your amputation. Below is a list of common steps that you may be asked to do:

• Your surgeon will explain the procedure and ask if you have any questions.

• See your healthcare provider for an exam, and to work with your medical conditions.

• You will be asked to sign a consent form that gives permission to do the procedure. Read the form carefully and ask questions if something is not clear.

• Along with a complete medical history, your surgeon may do a physical exam to make sure that you are in otherwise good health. You may have blood or other tests.

• You will be asked to fast for 8 hours, generally after midnight.

• If you are pregnant or think you may be, tell your surgeon.

• Tell your surgeon if you are sensitive to or are allergic to any medicines, latex, tape, or local and general anesthesia.

• Tell your surgeon of all medicines (prescription and over the counter ) and herbal supplements that you are taking.

• Tell your surgeon if you have a history of bleeding disorders or if you are taking any blood-thinning (anticoagulant) medicines, aspirin, or other medicines that affect blood clotting. You may be told to stop these medicines before the procedure.

• You may be measured for an artificial limb.

• You may receive a sedative to help you relax.

• Based on your medical condition, your surgeon may request other specific preparation.

What happens during an amputation?

Talk with your surgeon about what to expect during your procedure. An amputation requires a stay in a hospital. Procedures may vary depending on the type of amputation, your condition, and your surgeon’s practices.

An amputation may be done while you are asleep under general anesthesia, or while you are awake under spinal anesthesia. If spinal anesthesia is used, you will have no feeling from your waist down. Your surgeon will discuss this with you in advance.

Generally, an amputation follows this process:

1. You will be asked to remove any jewelry, contact lenses, glasses, hearing aids, or other objects that may interfere with the procedure.

2. You will be asked to remove your clothing and put on a gown.

3. Before the procedure you will be asked to confirm which limb is to be amputated. That limb will be clearly marked.

4. An IV line may be started in your arm or hand.

5. You will be positioned on the operating table.

6. The anesthesiologist will keep track of your heart rate, blood pressure, breathing, and blood oxygen level during the procedure.

7. A thin, narrow tube (catheter) may be inserted into your bladder to drain urine.

8. The skin over the surgical site will be cleansed with an antiseptic solution.

9. To determine how much tissue to remove, the surgeon will check for a pulse at a joint close to the site. Skin temperatures, color, and the presence of pain in the diseased limb will be compared with those in a healthy limb.

10. After the incision, your surgeon may decide that more of the limb needs to be removed. The surgeon will keep as much of the functional stump length as possible. They will also leave as much healthy skin as possible to cover the stump area.

11. If the amputation is due to injury, the crushed bone will be removed and smoothed out to help with the use of an artificial limb. If needed, temporary drains that will drain blood and other fluids may be inserted.

12. After completely removing the dead tissue, the surgeon may decide to close the flaps. This is called a closed amputation. Or the surgeon may decide to leave the site open. This is called open flap amputation. In a closed amputation, the wound will be stitched closed right away. This is usually done if there is little risk of infection. In an open flap amputation, the skin will remain drawn back from the amputation site for several days so any infected tissue can be cleaned off. At a later time, once the stump tissue is clean and free of infection, the skin flaps will be stitched together to close the wound.

13. A sterile bandage or dressing will be applied. The type of dressing used will depend on the type of surgery done.

14. The surgeon may place a stocking over the amputation site to hold drainage tubes and wound dressings, or the limb may be placed in traction or a splint.

What happens after an amputation?

In the hospital

After the procedure, you will be taken to the postanesthesia care unit. Your recovery will vary depending on the type of procedure done and anesthesia used. The blood flow and feeling of the affected extremity will be checked. Once your blood pressure, pulse, and breathing are stable and you are alert, you will be taken to your hospital room.

You will get pain medicines and antibiotics as needed. The dressing will be changed and watched closely.

You will start physical therapy soon after your surgery. Rehabilitation is designed for your specific needs. It may include gentle stretching, special exercises, and help getting in and out of bed or a wheelchair. If you had a leg amputation, you will learn how to bear weight on your remaining limb.

There are specialists who make and fit prosthetic devices. They will visit you soon after surgery and will instruct you how to use the prosthesis. You may begin to practice with your artificial limb as early as 10 to 14 days after your surgery, depending on your comfort and wound healing process.

After amputation, you will stay in the hospital for several days. You will get instructions as to how to change your dressing. You will be discharged home when the healing process is going well and you are able to take care of yourself with assistance. Some patients may need to go to a rehab facility.

After surgery, you may have emotional concerns. You may have grief over the lost limb or a physical condition known as phantom pain. This is pain or other feeling in your amputated limb. If this is the case, you may receive medicines or other types of nonsurgical treatments.

At home

Once you are home, it's important to follow the instructions given to you by your surgeon. You will have detailed instructions on how to care for the surgical site, dressing changes, bathing, activity level, and physical therapy.

Take a pain reliever for soreness as advised by your surgeon. Aspirin or some other pain medicines may increase the chance of bleeding. Be sure to take only approved medicines.

Call your surgeon right away if you have any of these:

• Fever or chills

• Redness, swelling, or bleeding or other fluid leaking from the incision site

• Increased pain around the amputation site

• Numbness or tingling in the remaining arm or leg

You may resume your normal diet unless your surgeon tells you differently. Your surgeon may give you other instructions.

Long-term care

There have been many advances over the past several years in the surgery, rehabilitation, and prosthetic design. Correct healing and fitting of the artificial limb help to reduce the risk of long-term complications. An amputation requires adapting many parts of your life. Physical therapy can help.

If the amputation was the result of PAD, continued steps will need to be taken to prevent the condition so that it does not affect other parts of your body.

You may be advised to make lifestyle changes to help stop the progression of PAD. This includes:

• Maintain a healthy diet that does not exceed your daily calorie requirement and that is low in saturated fat and cholesterol.

• Stop smoking.

• Work towards getting or keeping an ideal body weight.

• Maintain a regular exercise program.

• Keep track of your blood pressure to keep it in range.

• Control your blood sugar closely.

Next steps

Before you agree to the test or procedure make sure you know:

• The name of the test or procedure

• The reason you are having the test or procedure

• What results to expect and what they mean

• The risks and benefits of the test or procedure

• What the possible side effects or complications are

• When and where you are to have the test or procedure

• Who will do the test or procedure and what that person’s qualifications are

• What would happen if you did not have the test or procedure

• Any alternative tests or procedures to think about

• When and how you will get the results

• Who to call after the test or procedure if you have questions or problems

• How much you will have to pay for the test or procedure