When an existing condition or injury causes poor blood flow to a limb or digit, the cells and tissue in the affected area are not getting the oxygen and nutrients they need to stay healthy. If blood flow is not increased, these cells and tissue will die and become susceptible to infection. If the tissue is greatly damaged and/or infection sets in, especially if it is severe, amputation may be necessary in order to eliminate the damage or infection if it becomes life threatening. For patients over 50, amputation is most often caused by PAD. For patients under 50, a severe injury is the most common cause of amputation.
Preparing for Amputation
When considering amputation, your doctor will first examine you to ensure that it is the only option. Your doctor will look for:
- Very painful or cool skin in affected area
Before performing an amputation, your doctor wants you to be in the best health possible to contribute to the success of the surgery and lessen risks and complications. Existing conditions, such as high blood pressure, diabetes, and heart disease will be treated to get you in the best condition prior to surgery. Your strength, balance, and coordination will also be judged to prepare for rehabilitation. Additionally, your doctor may recommend you see a counselor prior to your amputation surgery to help you begin to cope with the loss of your limb. As with any surgery, current medications and allergies will be discussed during the examination as well.
At this time, your doctor will often suggest getting measured for your artificial limb. If the measurements are taken now, your artificial limb will be ready by the time your recovery is complete and your wound is sufficiently healed.
Before the surgery, your surgeon will determine the best incision site for your amputation. The surgeon’s ultimate goal is to remove all damaged tissue and retain as much healthy tissue as possible. If any diseased tissue remains, your wound may not heal and adjacent areas may be at risk of infection. To choose an incision site, your surgeon will assess the affected area and look for:
- Skin that is a healthy color, not reddish
- A pulse close to the proposed site
- Skin temperature similar to the temperature of a healthy limb
- Skin that is still sensitive to the touch
- Normal blood flow to the proposed site
After your anesthesia takes effect, an incision will be made at the pre-determined incision site and healthy skin will be left to cover your stump following surgery. Along the way, your surgeon will clamp blood vessels to reduce bleeding during the surgery. At the end of the procedure, the blood vessels will be stitched closed and your surgeon will remove the clamps to confirm that all vessels are secure. Your surgeon will also divide the muscles in the area and may even shape them to prepare your stump for an artificial limb.If your amputation is due to a severe injury, crushed bone and tissue will be removed (called debridement) and the bone will be smoothed to ensure a comfortable fit for an artificial limb. Your surgeon will also evaluate the wound and determine whether or not temporary drains should be placed to drain accumulated blood and fluids.
After all damaged tissue is removed, your surgeon will choose to perform an open flap amputation or a closed amputation. If your surgeon determines that an open flap amputation is needed, the skin around the amputation site will be left open for several days so that any infected tissue can be cleaned off. When the wound is clean and free of infection, a delayed closure is performed in which the skin flaps are sewn together to close the wound. If your surgeon is confident that your chance of infection is minimal, he or she will perform a closed amputation in which the skin flaps are sewn closed immediately following the surgery. After the wound is closed, a stocking may be placed over the stump to hold dressings and drainage tubes in place. Additionally, your limb may be placed in a splint or in traction.
Healing After AmputationAfter your amputation surgery, your hospital stay can last anywhere from 5 to 14 days. The dressings on your wound will be changed regularly, and your doctor will monitor how well your wound is healing. Existing conditions will continue to be monitored as well. Most likely, your doctor will prescribe pain medications and/or antibiotics to make you more comfortable and help with the healing process. Generally, amputation wounds fully heal in four to eight weeks.
Most often, physical therapy will begin shortly after your surgery. Physical therapy may include stretching, exercises such as getting in and out of a wheelchair, and strengthening your remaining limb. Typically, practice with your artificial limb will begin at least two weeks after your surgery. However, if your doctor approves, practice may start as early as ten days post-surgery.
It is not uncommon to experience emotional grief and/or phantom pain (a sense of feeling pain in your amputated limb) after amputation. A counselor and/or medication can help resolve these feelings.
Risks & Complications
As with all surgeries, complications may occur after an amputation. Treatable complications may include:
- Severe bruising (hematoma)
- Necrosis (tissue death of skin flaps covering wound)
- Contracture (joint deformity)
- Poor healing