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Amputation -- General Overview

Definition

An amputation is a surgery to remove a body part. It is removed because of disease or damage.
Above the Knee Amputation
cropped leg
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Reasons for Procedure

An amputation is typically done for one of the following reasons:
  • Peripheral arterial disease (PAD) causing:
    • Gangrene
    • Untreatable pain
    • Severe soft tissue infection
  • Severe trauma that cannot be repaired
  • Complications of diabetes
  • Untreatable bone infection ( osteomyelitis )
  • Malignant tumor
  • Congenital deformity (present at birth)
  • Severe frostbite
  • Complications of connective tissue diseases, such as:

Possible Complications

If you are planning to have an amputation, your doctor will review a list of possible complications, which may include:
  • Poor healing at amputation site, resulting in the need for a higher level of amputation
  • Skin breakdown
  • Infection
  • Bleeding
  • Swelling at surgical site
  • Phantom limb pain —feeling pain in amputated limb area
  • Phantom sensation—feeling that amputated limb is still there
  • Blood clots
  • Complications of anesthesia
Before your procedure, talk to your doctor about ways to manage factors that may increase your risk of complications such as:

What to Expect

Prior to Procedure

Your amputation may be planned. In this case, your doctor will review with you how it is done and what to expect. An emergency amputation may need to be done. This can happen because of trauma or life-threatening infection. In this case, you may not have this preparation.
Depending on the injury and location, your doctor may do some of the following before your surgery:
  • Imaging studies to look at the bones and surrounding tissue for evidence and location of disease or trauma, including:
  • Tissue cultures
  • Blood tests
  • Heart evaluation
  • Preoperative antibiotics
  • Tests to evaluate blood flow in the part of the body that is being amputated
Leading up to your surgery:
  • Arrange for a ride home from the hospital.
  • Arrange for help at home after your surgery.
  • Follow instructions for eating before surgery—usually nothing after midnight.
  • You may be asked to use an antibacterial soap the morning of your surgery.

Anesthesia

This will depend on the body part operated on. You may receive:

Description of Procedure

An incision will be made into the skin of the affected limb or limb part. If needed, the muscles will also be cut. Blood vessels will be tied off or sealed to prevent bleeding. The bone will then be cut through. The diseased or damaged body part will be removed.
Muscle will be pulled over the bone. It will be sutured in place there. The remaining skin will be pulled over the muscle. The skin will be sewn to form a stump. A sterile dressing will be placed over the incision.
If severe infection is involved, the incision may be left open to heal.

How Long Will It Take?

This procedure can take 20 minutes to several hours. The length will depend on the type of amputation being done and your overall state of health.

How Much Will It Hurt?

Anesthesia will prevent pain during surgery. Pain and discomfort after the procedure can be managed with medications.

Average Hospital Stay

Your hospital stay will depend on the type of amputation you had. Typically:
  • Foot or toe amputation: 2-7 days
  • Leg amputation: 2 days to 2 weeks or more
  • Upper extremity: 7-12 days
  • Finger amputation: 0-1 day
Your doctor may choose to keep you longer if complications arise.

Post-procedure Care

At the Hospital
After surgery, you can expect some of the following:
  • The area involved will be elevated. This will decrease swelling.
  • Your limb will be dressed in bulky dressing, elastic bandage, or cast.
  • You will be encouraged to get up and walk as soon as possible.
  • Physical therapy will begin within a day or two of surgery. It will focus on improving strength and mobility.
  • You may wear a cast or special shoe for toe/foot amputations.
  • You may be given certain medicines. This may include antibiotics or blood thinners.
  • You will be fitted with a prosthesis as soon as your wound has healed.
Preventing Infection
During your stay, the hospital staff will take steps to reduce your chance of infection, such as:
  • Washing their hands
  • Wearing gloves or masks
  • Keeping your incisions covered
There are also steps you can take to reduce your chance of infection, such as:
  • Washing your hands often and reminding your healthcare providers to do the same
  • Reminding your healthcare providers to wear gloves or masks
  • Not allowing others to touch your incision
At Home
Stitches will be removed within a few weeks of surgery. When you return home, do the following to help ensure a smooth recovery:
  • Follow the instructions for keeping your incision clean .
  • Follow instructions on how to care for your prosthesis.
  • Counseling may be recommended for the emotional trauma of an amputation.
  • Attend follow up appointments with your doctor. They will make sure you are healing well.
  • Check with your doctor about which medicines to take at home.
  • Maintain a healthy body weight for overall health and to make sure your prosthesis fits well.
  • Keep your blood vessels healthy:
    • If you smoke, quit. Smoking can interfere with healing.
    • Avoid foods that are high in fat and cholesterol.
    • If you are diabetic, check your blood sugar levels and eat right.
    • Exercise regularly.
Also, ask your doctor about when it is safe to shower, bathe, or soak in water.

Call Your Doctor

Call your doctor if any of these occur:
  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision sites
  • Increasing or excessive pain
  • Cough, shortness of breath, or chest pain
  • Severe nausea and vomiting
If you think you have emergency, call for medical help right away.

RESOURCES

American Academy of Orthopaedic Surgeons http://www.aaos.org

Amputee Coalition of America http://www.amputee-coalition.org

CANADIAN RESOURCES

The Canadian Orthopaedic Foot & Ankle Association http://www.coa-aco.org

Canadian Orthopaedic Foundation http://www.canorth.org

References

Amputation. Society for Vascular Surgery website. Available at: http://www.vascularweb.org/patients/NorthPoint/Amputation.html. Accessed November 17, 2008.

Amputation of the foot or toe. EBSCO Health Library website. Available at: http://healthlibrary.epnet.com/GetContent.aspx?token=D39207C8-9100-4DC0-9027-9AC6BA11942D&chunkiid=14763. Accessed November 17, 2008.

Amputation of the hand or finger and prosthetics. American Society for Surgery of the Hand website. Available at: http://www.assh.org/Content/NavigationMenu/PatientsPublic/HandConditions/AmputationandProsthetics/Amputation%5Fand%5FPros.htm. Accessed November 17, 2008.

Badash M. Amputation, above the knee. EBSCO Health Library website. Available at: http://healthlibrary.epnet.com/GetContent.aspx?token=D39207C8-9100-4DC0-9027-9AC6BA11942D&chunkiid=14822. Accessed November 17, 2008.

Bone Sarcoma in the Upper Extremity: Treatment Options Using Limb Salvage or Amputation. American Academy of Orthopaedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00092#Rehabilitation/Convalescence. Accessed November 18, 2008.

Buerger’s disease: what is it? Vascular Disease Foundation website. Available at: http://www.vdf.org/diseaseinfo/buergers. Updated October 31, 2008. Accessed December 16, 2008.

Fingertip injuries/amputations. American Academy of Orthopaedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00014. Accessed November 18, 2008.

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