Amputation

Introduction

Amputation is the surgical removal of all or part of a limb or extremity such as an arm, leg, foot, hand, toe, or finger. As a surgical measure, it is used to control pain or a disease process in the affected limb, such as malignancy or gangrene.

Why

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.

Evaluation

Unless you need to have an emergency amputation, you'll be fully assessd before surgery to identify the most suitable type of amputation and any factors that may affect your rehabilitation.

The assessment is likely to include:

A thorough medical examination – assessing your physical condition, nutritional status, bowel and bladder function, your cardiovascular system (heart, blood and blood vessels) and your respiratory system (lungs and airways)

An assessment of the condition and function of your healthy limb – removing one limb can place extra strain on the remaining limb, so it's important to look after the healthy limb

A psychological assessment – to determine how well you'll cope with the psychological and emotional impact of amputation, and whether you'll need additional support

An assessment of your home, work and social environments – to determine whether any additional provisions will need to be made to help you cope

You'll also be introduced to a physiotherapist, who will be involved in your post-operative care. A prosthetist (a specialist in prosthetic limbs) will advise you about the type and function of prosthetic limbs or other devices available.

If you're having a planned amputation, you might find it reassuring to talk to someone who's had a similar type of amputation. A member of your care team may be able to put you in touch with someone.

How

 Amputations can be carried out under general anaesthetic (where you're unconscious) or using an epidural anaesthetic (which numbs the lower half of the body).

Once the limb has been removed, a number of additional techniques can be used to help improve the function of the remaining limb and reduce the risk of complications.

These include shortening and smoothing the bone in your remaining limb so it's covered by an adequate amount of soft tissue and muscle, and stitching the remaining muscle to the bones to help strengthen your remaining limb (a technique known as myodesis).

After the amputation, your wound will be sealed with stitches or surgical staples. It will be covered with a bandage and a tube may be placed under your skin to drain away any excess fluid. The bandage will usually need to be kept in place for a few days to reduce the risk of infection.

Recovery

 After surgery, you'll usually be given oxygen through a mask and fluids through a drip for the first few days while you recover on the ward.

A small flexible tube (a urinary catheter) may be placed in your bladder during surgery to drain away urine. This means you won't need to worry about going to the toilet for the first few days after surgery.

The site of the operation may be painful, so you'll be given painkillers if you need them. Tell a member of your care team if the painkillers aren't working, as you may need a larger dose or a stronger painkiller. A small tube may be used to deliver local anaesthetic to the nerves in your stump to help reduce pain.

Your physiotherapist will teach you some exercises to help prevent blood clots and improve your blood supply while you're recovering in hospital. 
You'll notice swelling (oedema) of your stump after surgery. This is normal and it may continue after you've been discharged.
Using a compression garment will help with swelling and the shape of the stump. It may also reduce phantom pain and help support the limb.

You'll be fitted with a compression garment once your wound has healed. It should be worn every day, but taken off at bedtime. You should be given at least two garments, which should be washed regularly.

Rehabilitation

 Physical rehabilitation is an important part of the recovery process. It can be a long, difficult and frustrating process, but it's important to persevere. After rehabilitation, you should be able to return to work and other activities.

Your rehabilitation programme will be tailored to your individual needs and requirements, and will aim to allow you to carry out as many of your normal activities as possible.

You'll work closely with physiotherapists and occupational therapists who will discuss with you what you'd like to achieve from rehabilitation so that some realistic goals can be set.

Your rehabilitation programme will usually start within a few days of surgery, beginning with some simple exercises you can do while lying down or sitting. If you've had a leg amputation, you'll be encouraged to move around as soon as possible using a wheelchair.

You'll also be taught "transfer techniques" to help you move around more easily, such as how to get into a wheelchair from your bed.

Once your wound has started to heal, you may start working on an exercise programme with a physiotherapist in the hospital gym to help you maintain your mobility and muscle strength.

Complications

 Like any type of surgery, an amputation carries a risk of complications. It also carries a risk of additional problems directly related to the loss of a limb.

There are a number of factors that influence the risk of complications from amputation, such as your age, the type of amputation you've had, and your general health.

The risk of serious complications is lower in planned amputations than in emergency amputations.

Complications associated with having an amputation include:

Heart complications – such as heart attack

Deep vein thrombosis (DVT)

Slow wound healing and wound infection

Pneumonia

Stump and "phantom limb" pain

In some cases, further surgery may be needed to correct problems that develop or to help relieve pain. For example, if neuromas (thickened nerve tissue) are thought to be causing pain, the affected cluster of nerves may need to be removed.