A B C D E F G H I J K L M N O P R S T U V W

AMPUTATION

What is Amputation ?

Almost all leg amputations are performed because you are suffering from the effects of blood vessel disease. This means that you have either hardening of the arteries, poor artery circulation or a large clot in the artery which cannot be removed. Less common reasons include cancer, severe injury or infection, and congenital deformities. The most likely cause for amputation in patients with severe artery disease is the presence of severe pain or the possible development of gangrene. Amputation, however, is always a last resort and will only be recommended if it does not look possible to improve the circulation in any other way. Arm amputations are much less common and are usually needed because of extensive injury.

Preparations needed for Amputation

As amputation is most often performed as an urgent or even emergency procedure, it is unusual to have much time to prepare. Sometimes there may be time for you to discuss the outlook with another patient who has had an amputation. Likewise, it may be helpful for you to discuss the situation with the hospital physiotherapists and any other staff who will be involved in your post-operative management. Recovery from amputation and learning to walk again with an artificial leg will take several weeks or even months.

What Happens during Amputation

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. You will 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.

After Amputation

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 artifical leg 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. An occasional patient may not be suitable to even 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 by help from skilled physiotherapists and nursing staff who are used to caring for amputation patients.

If Amputation is not performed

With severe blood vessel disease, the likely 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.