• 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
    Copyright © Nucleus Medical Media, Inc.

    Reasons for Procedure

    An amputation is typically done for one of the following reasons:

    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
    Some factors that may increase the risk of complications include:
    • Peripheral vascular disease
    • Diabetes
    • Infection
    • Prolonged immobility
    • Heart disease
    • Smoking or lung disease
    • Blood clotting disorders
    • Certain medicines (eg, steroids)

    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:
    • X-rays —a test that uses radiation to take a picture of structures inside the body, especially bones
    • CT scan —a type of x-ray that uses a computer to make pictures of structures inside the body
    • MRI scan —a test that uses magnetic waves to make pictures of structures inside the body
    • Bone scan to check for infection
    • 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.

    How Much Will It Hurt?

    During the surgery, anesthesia will block any pain. After surgery, you will feel pain as you begin to heal. Your doctor will give a medicine to help manage pain. You may feel phantom pain, which is a feeling of pain in the amputated portion of the limb that is no longer present. If you do, tell your doctor so it can be treated.

    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
    • 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.
    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:
    • If you smoke, quit . Smoking can interfere with healing.
    • 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.
    Also, ask your doctor about when it is safe to shower, bathe, or soak in water.

    Call Your Doctor

    After you leave the hospital, call your doctor if any of the following occurs:
    • 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
    In case of an 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/

    Society for Vascular Surgery http://www.vascularweb.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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