Amputation

When you have a blockage or narrowing of the arteries supplying your legs, the circulation to your legs is reduced. You may have developed pain in your foot or feet waking you at night, ulceration, or black areas on your toes, feet or leg.

If severe arterial disease is left untreated, the lack of blood circulation will cause the pain to increase. Tissues in the leg will die due to lack of oxygen and nutrients, which leads to infection and gangrene. In some cases, gangrene can be very dangerous as the infection can spread through the body and become life-threatening.

Amputation is always a last resort and will only be recommended if

• It is not possible to improve the circulation in any other way
• Infection is so severe that major amount of tissue is dying with a risk to rest of your limb or life

The sites of amputation are :

• Just below the knee
• Through the thigh
• Middle of foot
• Toe
• Below elbow
• Above elbow
• Finger

The site of amputation will depend on how the damage to your leg is. Remember A PROPER AMPUTATION DONE IN TIME is very important for using prosthetic limb and mobility.

The Operation

In the anaesthetic room you will be given a general anaesthetic to put you to sleep. Alternatively, you can have a tube inserted into your back through which pain killers can be given to numb the lower half of your body whilst you remain awake (spinal or epidural). The anaesthetist may also use an epidural as well as a general anaesthetic to provide pain relief after your surgery.

After The Operation

You will usually return to the ward once you have recovered from the anaesthetic. You will be given fluids by a drip in one of your veins until you are well enough to sit up and take fluids and food by mouth. The nurses and doctors will try and keep you free of pain by giving pain killers by injection, via a tube in your back.

It is quite common to experience pain that feels as though it is in part of the leg that has been removed (phantom limb pain) and this can be helped with medication and rapidly disappears. As you recover, the various tubes will be removed and you will become gradually more mobile until you are fit enough to go home.

You will be visited by the physiotherapist before and after your operation who will help you with your breathing (to prevent you developing a chest infection) and with your mobility. Initially you will be shown exercises in bed and then you will be encouraged to transfer from your bed to a chair.

As your wound heals, the physiotherapist will support you in walking by temporary artificial limbor walker. The principle is to moblise the patient from bed.

You will also be visited by an occupational therapist who will help with your rehablitation. Even if you are planning to walk, you may still need a wheelchair temporarily or for long trips.

An appointment will be made for you to have an artificial limb fitted at the limb fitting centre, which will look like your other leg when your clothes are on.

Going Home

Some alterations may be necessary at your home before you are discharged and in some cases it may be necessary for you to move into different accommodation. Once you have left hospital, you will need to continue to attend the physiotherapy department to help you become independent with your artificial limb or wheelchair.

Complications

Because of the poor blood supply, wound healing can sometimes be slow and very occasionally it is necessary to perform another amputation higher up the leg if the wound does not heal.

The wound can become infected and if so, will require treatment with antibiotics.

Aches and numbness in the wounds are common and may continue for several months.

Chest infections can occur following this type of surgery, particularly in smokers, and may require treatment with antibiotics and physiotherapy.

As with any operation, there is a small risk of a heart attack or stroke or even of dying as a result of the operation.

What can I do to help myself?

If you were previously a smoker, you must make a sincere and determined effort to stop as this may damage the circulation in your other leg.

It is also important that you do not put on weight, as this will make mobilising with a wheelchair or artificial leg more difficult. Eat plenty of fresh fruit and vegetables.

Take good care of your remaining foot. Keep it clean and protected from injury by wearing a well-fitting shoe. The orthotist can provide special footwear and if required, a chiropodist could cut your toenails.

If you are diabetic, you should control your blood pressure as this is extremely important for your overall rehabilitation and future health.

IT IS EXTREMELY IMPORTANT TO MOVE AND EXCERCISE

Life after Amputation

Amputation is perceived commonly as a life ending event which is very contrary to the real world scenario now. Artificial limbs (Modular prosthesis) are available now are capable of giving you independent walking ability and if required to actively run and engage in sports too provided you have the motivation and fitness to do so. You will be helped by the physiotherapists, nurses and doctors at the limb fitting centre.

Driving: May be possible with an amputation, either with an automatic car, or with some special modifications.