Amputation is a surgical procedure to remove a portion or all of a leg, foot, toe, arm, hand, or finger. The procedure might be a necessity to treat an injury, infection, or disease or to remove a tumor in a muscle or bone. Typically, amputations are performed because of low blood flow caused by a damaged or narrowed artery – referred to as peripheral arterial disease (PAD) if it involves a leg or arm.
- When Amputation Is the Only Option
- Who Is at Risk for an Amputation?
- Pre-Surgery Assessment
- Typical Post-Surgical Amputation Complications
- Post-Amputation Treatments
- Returning Home After the Amputation
When Amputation Is the Only Option
In many cases, doctors have no other than to amputate a limb due to a severe infection, peripheral arterial disease, the presence of gangrene, or because serious trauma that has affected the limb. This could be caused by a blast wound or crushed tissue and bones or deformity that limits function and movement.
In amputation may be required if the limb has been severely burned, suffers cancer or has been injured by some form of accident. A serious infection that did not respond to antibiotic medications might lead to a limb amputation or because of diabetes, neuroma (malignant neurofibroma tumor) or frostbite.
Who Is at Risk for an Amputation?
The doctors may perform an amputation on any individual is undergone serious trauma to a limb caused by an accident, infection, malignant growth, frostbite or other external force. However, individuals who suffer from heart disease, diabetes or other complications could require amputation of the limb.Associated Complications
Many of the complications associated with amputating a limb occur in above-the-knee amputations that are significantly riskier than having an amputation below the knee. The most common associated complications that occur from an amputation involve:
- Joint deforming
- Necrosis (tissue death),
- Opening of the wound
- Bruising that produces a hematoma when blood collects underneath the skin
- Blood clots that develop in the lung or the deep veins in the limb
Based on the patient's condition, there are other known associated risks that can be managed by the doctor using medications and other surgical procedures.
Unless the patient needs an emergency amputation, the doctor will perform a comprehensive assessment prior to the surgical procedure. The assessment identifies the most suitable means for amputating all or part of the limb and accounts for any factor that could affect the patient's rehabilitation. The assessment usually involves:
- Comprehensive Medical Examination – Doctors will assess the patient's physical condition, bladder or bowel function, nutritional status and cardiovascular system including the blood vessels, blood, and heart. The physician will also check the lungs and airways of the respiratory system.
- The Function and Condition of the Health Limb – The result of amputating one limb usually places a significant strain or burden on the remaining functioning limb that could cause complications and problems in the near or distant future.
- Psychological Assessment – Coping with an amputation can have an emotional and psychological impact on the patient who will likely require additional support for years.
- Assessment of the Patient's Environments – Provisions will likely need to be made to help the individual in their work, social and home environments to cope with the changes that need to be made in living with an amputated limb.
Before the amputation occurs, the patient will usually receive information and recommendations from a physiotherapist who will assist the patient with postoperative care. Prior to the surgical procedure, the surgeon often discusses with the patient exactly what to expect including the need to remain in the hospital and whether the procedure will be performed while awake or under spinal or general anesthesia.
Post-Surgical Amputation Complications
Amputation surgeries can develop serious complications. The surgeon will make an effort to ensure that the remaining portion of the limb is reconstructed appropriately while considering only, soft tissue viability and other anatomical issues. Even so, any underlying disease or postoperative problem could create complications including:
- Edema (excessive water fluid buildup in body tissue)
- Associated wounds
- Joint instability
- Muscle contractures
- Muscle weakness
- Autonomic dysfunction that involves distal pain and motor and autonomic dysfunction
- Pain including post-amputation pain, residual limb pain, phantom limb sensation, and phantom limb pain
- Vascular pain
- Muscle skeletal pain
- Prosthetic pain caused by an ill-fitting socket, incorrect alignment
- Incorrect pressure distribution
- Excessive sweating
- Incorrectly wearing the prosthesis
Every individual undergoing an amputation will require postoperative wound care that usually involves a "drain in situ" that is removed a day or two after the surgery. The drainage usually removed without disturbing the dressing or bandages because it was never sutured in the place.
Surgeons expect successful healing from the procedure without any complications. However, wound infections do occur at a significantly high rate producing certain complications including dehiscence where a biological release splits tissue and skin caused by a natural burst of a surgically closed wound and skin blistering.
The treating doctor or surgeon likely prescribed antibiotics and pain medications to be used when needed and the dressings will be changed in the hospital while closely watching the wound. Typically, the patient begins physical therapy soon after the surgery has concluded. Rehabilitation considers the specific needs of the patient but almost always involves special exercises, gentle stretching, and transferring in and out of a wheelchair or bed. Individuals who have had a leg amputated must learn the most efficient way to bear their body weight on the remaining limb.
At some point, the patient will visit a specialist who will measure, make and fit a prosthetic device. This will be followed by artificial limb (prosthesis) instructions and practice that can occur within the first 10 days to 14 days after the surgery is performed. Before the patient leaves the hospital to return home, the nursing staff will provide instructions how to change the dressing.
The doctor will consider all the emotional concerns the patient experiences including the grief involved in losing a limb or any physical condition that is causing phantom discomfort or pain that can be felt in the limb no longer there. The doctor may prescribe medications or recommend other forms of nonsurgical approaches to deal with the physical, emotional, and mental needs of the patient.
Returning Home After the Amputation
Once the patient has returned home, it is crucial that they follow the instructions provided by the surgeon and the nursing staff. This includes caring for the surgical site, performing sterilized dressing changes, participating in activities, bathing, and physical therapies. The patient will likely need pain relieving medications including non-steroid anti-inflammatory drugs and aspirin that could increase the potential risk of bleeding.
It is important that the patient discusses any complications that may arise at home including:
- Developing chills and/or fever
- Experiencing tingling or numbing sensation in the remaining leg or arm
- Experiencing intense pain at the amputation site
- Bleeding, swelling, or redness at the incision site
- Incision site drainage
The doctor will likely prescribe long-term care that could include maintaining a healthy diet, monitoring saturated fat and cholesterol levels, taking steps to quit smoking, participating in a routine exercise program, and working toward obtaining or maintaining an ideal body weight.