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Amputation

(See also Peripheral Arterial Disease, Exercise)

What is an amputation?

An amputation is when a surgeon removes a limb, or part of a limb, that is no longer useful to you and is causing pain, or is otherwise threatening your health (such as when the limb has an infection).  While an amputation may be performed due to traumatic injury (such as a car crash), or a tumor, within the context of vascular surgery an amputation is most often performed when the patient is suffering from peripheral arterial disease (PAD).  Physicians as well as patients consider amputation a last resort.

In PAD, the blood vessels in your limbs become damaged because of hardening of the arteries or diabetes. Your body’s cells depend on a constant supply of oxygen and nutrients delivered to them by your blood.  If your blood flow slows too much, or even ceases, any small injury to the area will be unable to heal and may eventually become infected, threatening your health even further.  If circulation cannot be improved, or if the limb tissue is beyond salvage (it has already started to become gangrenous), then an amputation may be the only option particularly if you are experiencing severe pain, or an infection has already set in.

How do I prepare?

Your physician will perform a physical examination to determine whether your limb can be saved or if you need an amputation. He or she will check you for:

  • Fever
  • Cool skin near your wound
  • Extremely painful skin
  • Wound odor
  • Infected or non-healing sores or wounds

Your physician will also arrange for tests to see how well blood is reaching your limbs. These tests may include blood pressure tests, duplex ultrasound, and angiography. Sometimes computed tomography or magnetic resonance imaging is used.

If you have any other conditions, such as diabetes, high blood pressure, heart problems, poor kidney function, or infections, your physician will discuss with you how to treat them to get you in the best condition. Your physician will also test your physical strength, balance, and coordination to assess your potential for rehabilitation. If you are going to use an artificial limb, sometimes your physician may arrange for you to be measured for the device before your operation. This way, your artificial limb will be ready as soon as you recover. Often, however, your physician may advise waiting until your incision is healed adequately before getting your artificial limb. You also may receive counseling before your surgery to help you adapt to the loss of your natural limb.

Your physician will discuss with you whether to reduce or stop any medications that might increase your risk of bleeding or other complications. If you have any allergies to anesthesia, pain medications, or antibiotics, you should tell your physician at this time.

When do I need amputation?

Most people who require an amputation have PAD, a traumatic injury, or cancer.

PAD is the leading cause of amputation in people age 50 and older, and accounts for up to 90 percent of amputations overall. Normally, surgeons treat advanced PAD through other methods, like controlling infection using antibiotics and draining or removing any infected tissue as well as performing surgery or other procedures to increase the blood flow to the affected area. However, if these treatments do not work, or if the tissue damage is too far advanced initially, amputation will remove a source of major infection and may be necessary to save your life.

Your physician may recommend amputation if you have a cancerous tumor in your limb. You may also receive chemotherapy, radiation, or other treatments to destroy the cancer cells. Depending upon the particular circumstances, these treatments can shrink the tumor and may increase the effectiveness of your amputation.

Am I at risk for complications during amputation?

If you have other conditions, like diabetes or heart disease, you have a higher risk of complications from an amputation. Having a very serious traumatic injury also increases your risk of complications. Above-the-knee amputations can be associated with more risk than below-the-knee amputations, because people who require above-the-knee amputations are more likely to be in poorer health. Depending upon your particular situation, your physician will attempt to save as much of your limb as is possible.

What happens during amputation?

To perform an amputation, your physician must remove your diseased limb but preserve as much healthy skin, blood vessel, and nerve tissue as possible.

If you would like more detailed information about what your surgeon will do, please visit Vascular Web, provided by the Society for Vascular Surgery.

What can I expect after amputation?

After your surgery, you will stay in the hospital for approximately 5 to 14 days, depending upon your particular situation. Your physician may teach you how to change your wound dressings, or the hospital staff will change them for you. Your physician usually checks the progress of your wound in about 7 to 10 days, or as often as necessary. Your physician will also monitor any conditions you have that might slow your healing, such as hardening of the arteries or diabetes. If you need pain medications or antibiotics, your physician will prescribe them. Ideally, your wound should fully heal in about 4 to 8 weeks after your surgery.

If your condition permits, you will receive physical therapy soon after your surgery. Physical therapy includes gentle stretching for the first 2 or 3 days. Later, you will perform exercises, such as getting in and out of your bed or in and out of your wheelchair. Eventually, you will learn how to bear your weight on your remaining limb.

Depending upon your particular situation and your comfort and wound healing progress, you may also begin to practice with your artificial limb as early as 10 to 14 days after your surgery. However, it is common to require more time before you are ready for this.

You may experience phantom pain (a sense of feeling pain in your amputated limb) or other emotional concerns, such as grief over the lost limb, after surgery. If this is the case, your physician can recommend counseling or drug therapy, as appropriate.

Are there any complications?

You may have complications following any surgical procedure. Complications that occur specifically from amputation include a joint deformity called contracture, a severe bruise called a hematoma, death of the skin flaps (necrosis), wound opening from poor healing, or infection. Your surgeon or physician can treat all of these complications. Rarely, you may need to undergo further surgical treatment or another amputation procedure.