The decision to have a limb amputated is difficult for the person and his or her doctor. Many times, extensive measures have been tried to save the limb.
Tobacco use may be the most important factor in progressing to amputation. In doing the amputation, the surgeon seeks to remove all dead or dying tissue.
Goals of amputation are to relieve pain, encourage wound healing, and increase a person's ability to carry out his or her daily activities. Amputations and bypass grafting surgery may be planned at the same time to achieve the best results.
For example, a person who has gangrene may have an amputation of part of the foot or leg while also having bypass grafting in an attempt to preserve still-living tissue.
Preoperative care before amputation is similar to any major surgery. People with major medical problems, such as diabetes or heart, lung, or kidney problems must be carefully assessed and their medical care optimized before the operation. The importance of the preoperative evaluation cannot be overemphasized. People who have amputations are often chronically or seriously ill. And their risk of dying around the time of the operation as well as in the following years is higher than for other people of the same age.
The appropriate amputation level depends on a number of factors, including why the amputation is needed, the general health of the person, the possibility for recovery and rehabilitation rehab , and the probability of adequate wound healing. The nerve procedures may also be performed later for patients who have already had an amputation and are still experiencing severe nerve pain.
In the early part of their recovery, patients who have lost a foot or leg are at risk for falling. This is especially likely if they try to get out of bed at night and forget that the amputation has occurred. These falls can be serious, and can cause further damage to the surgical site that requires additional care — perhaps more surgery.
Placing a walker or wheelchair next to the bed can remind you not to attempt standing and walking without assistance. Rehabilitative therapy and exercises performed while looking in a mirror can help the patient adapt to the loss of the limb and avoid falling. Uncontrolled pain can be a complication of any surgery, and the amputation team works hard to make sure pain is manageable.
Pain control regimens may begin before surgery if possible. A peripheral nerve block might be necessary to control pain and phantom limb sensations.
Health Home Treatments, Tests and Therapies. What You Need to Know Amputation can be traumatic due to an accident or injury or surgical due to any of multiple causes such as blood vessel disease, cancer, infection, excessive tissue damage, dysfunction, pain, etc. What are the causes of amputation? Amputation for Severe Infection Severe sepsis is also called septicemia or blood poisoning. What is congenital amputation? Types of Amputation Surgery The surgical approach depends on the affected body part, the reason for the amputation and the extent of bone and tissue damage.
The Amputation Surgery Team Orthopaedic and orthopaedic oncologic surgeons work with a plastic and reconstructive surgeon, along with a range of nurses and surgical technologists, to perform a surgical amputation procedure. Some of the common amputation approaches include: Standard Amputation The surgeons remove the limb, and anchor muscles to the cut end of the bone and cover it with skin. Osseointegration OI Surgeons remove a body part and insert a steel implant into the stump of the leftover bone.
Rotationplasty During rotationplasty , which might be a choice for some patients with a tumor in bone or soft tissue, surgeons remove the part of the limb where the cancer is, and any healthy tissue below the tumor is turned around and re-attached. If the doctor gave you a prescription medicine for pain, take it as prescribed. If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
If you think your pain medicine is making you sick to your stomach: Take your medicine after meals unless your doctor has told you not to. Ask your doctor for a different pain medicine. If your doctor prescribed antibiotics, take them as directed.
Do not stop taking them just because you feel better. You need to take the full course of antibiotics. Rehabilitation is a series of exercises you do after your surgery. This helps you learn to use your remaining limb and artificial leg. You will work with your doctor and physiotherapist to plan this exercise program.
To get the best results, you need to do the exercises correctly and as often and as long as your doctor tells you. Your rehab program will give you a number of exercises to do. Always do them as your therapist tells you. Preventing contractures is very important. A contracture occurs when a joint becomes stuck in one position.
If this happens, it may be hard or impossible to straighten your remaining limb and use an artificial leg. Make sure you put equal weight on both hips when you sit. Use firm chairs, and sit up straight. Keep your remaining limb flat with your legs together while you are lying on your back.
Lie on your stomach as much as possible to stretch your hip joint. Do not sit for more than an hour or two. Stand, or lie on your stomach now and then. Do not put pillows under your hips or knees or between your thighs.
For example, call if: You passed out lost consciousness. You have chest pain, are short of breath, or you cough up blood. Call your doctor or nurse call line now or seek immediate medical care if: You have pain that does not get better after you take pain medicine. You are sick to your stomach or cannot drink fluids. You have loose stitches, or your incision comes open. You have signs of a blood clot in your leg called a deep vein thrombosis , such as: Pain in your calf, back of the knee, thigh, or groin.
Occasionally, these can be painful phantom limb pain. The term "phantom" does not mean the sensations are imaginary. Phantom limb pain is a real phenomenon, which has been confirmed using brain imaging scans to study how nerve signals are transmitted to the brain. The symptoms of phantom limb pain can range from mild to severe. Some people have described brief "flashes" of mild pain, similar to an electric shock, that last for a few seconds.
Others have described constant severe pain. Stump and phantom limb pain will usually improve over time, but treatments are available to help relieve the symptoms. There are several non-invasive techniques that may help relieve pain in some people. They include:. Research has shown that people who spend 40 minutes a day imagining using the part of their limb that was amputated, such as stretching out their "fingers" or bunching up their "toes", experience a reduction in pain symptoms.
This may be related to the central theory of phantom limb pain. Researchers think the brain looks to receive feedback from an amputated limb, and these mental exercises may provide an effective substitute for this missing feedback. Another technique, known as mirror visual feedback, involves using a mirror to create a reflection of the other limb. Some people find that exercising and moving their other limb can help relieve phantom pain.
The loss of a limb can have a considerable psychological impact. Many people who've had an amputation report emotions such as grief and bereavement, similar to experiencing the death of a loved one. Coming to terms with the psychological impact of an amputation is therefore often as important as coping with the physical demands.
Having an amputation can have a considerable psychological impact for three main reasons:. Negative thoughts and emotions are common after an amputation. This is particularly true in people who've had an emergency amputation because they don't have time to mentally prepare for the effects of surgery.
Common emotions and thoughts experienced by people after an amputation include:. People who've had an amputation as a result of trauma particularly members of the armed forces also have an increased risk of developing post-traumatic stress disorder PTSD. Talk to your care team about your thoughts and feelings, particularly if you're feeling depressed or suicidal.
You may need additional treatment, such as antidepressants or counselling , to improve your ability to cope after having an amputation. Being told you need to have a limb amputated can be a devastating and frightening experience. Adjusting to life after an amputation can be challenging, but many people enjoy a good quality of life once they have managed to adapt.
There are a number of charities that can provide advice and support for people living with amputations, which include:. Page last reviewed: 12 August Next review due: 09 August Why amputation may be needed An amputation may be needed if: you have a severe infection in your limb your limb has been affected by gangrene often as a result of peripheral arterial disease there's serious trauma to your limb, such as a crush or blast wound your limb is deformed and has limited movement and function Assessment before surgery Unless you need to have an emergency amputation, you'll be fully assessed before surgery to identify the most suitable type of amputation and any factors that may affect your rehabilitation.
How amputations are done Amputations can be done under general anaesthetic where you're unconscious or using either an epidural anaesthetic or spinal anaesthetic both of which numb the lower half of the body. Recovering after an amputation After surgery, you'll usually be given oxygen through a mask and fluids through a drip for the first few days while you recover in a ward.
Compression garments You'll notice swelling oedema of the stump after surgery. Rehabilitation Physical rehabilitation is an important part of the recovery process.
Going home and follow-up The length of time it will take before you're ready to go home will depend on the type of amputation you've had and your general state of health. Prosthetic limbs After an amputation, you may be able to have a prosthetic limb fitted. If you're able to have a prosthetic limb, the type of limb that's recommended for you will depend on: the type of amputation you had the amount of muscle strength in the remaining section of the limb your general health tasks the prosthetic limb will be expected to perform whether you want the limb to look as real as possible or you're more concerned with function If it's thought that you would find it difficult to withstand the strain of using a prosthetic limb, a cosmetic limb may be recommended.
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