An amputation is the surgical removal of a limb or part of a limb.
An amputation may be indicated if:
- you have a severe infection in your leg or foot that isn't reponding to other treatments
- your limb has been affected by gangrene (often as a result of blocked arteries in your leg)
- following injury such as a crush or blast wound that has caused so much damage that the limb cannot be repaired
- your limb is deformed and has limited movement and function and your qaulity of life would be better after a sucessful amputation.
Assessment before surgery
All surgical procedures carry some risks. In most cases, you will be fully assessed before surgery to identify any medcial conditions that require treatment to reduce the risks. This assessment will also include a thorough medical examination and some investigations including blood tests, xrays, an ECG. Your surgeon may ask for an opinion for other specialists, particularly those looking after any chronic dieases that you might have such as diabetes or renal failure.
You will also be assessed by your anaesthetist either before you go to the operating suite or wehn you arrive in theatre reception.
Your surgeons will discuss the most appropriate level of amputation in your particular circumstances.
Surgical procedure
Amputations can be done under general anaesthetic (where you're unconscious), under an epidural or spinal anaesthetic or sometime under local nerve block. More than one of these types of anaesthesia may be combined. Your anaesthetist will advise which is most appropriate for you based on the procedure and your medcial conditions.
During the procedure, the affected part of your leg is removed by your surgeon. Normally, the removed tissue will be sent for incineration but if you would prefer to make other arrangements such as burial of the limb, you will be given an opportunity to discuss this before the procedure.
At the end of the procedure, the skin will normally be closed over the limb. Sometimes, especially after trauma or severe infection, the wound will be left open and either closed later (during another operation) or dressed with special dressings to speed up healing.
The wound will be covered with a dressing and a drain may be placed under your skin to drain any excess fluid. A nerve infusion catheter may also be placed to allow infusion of local anaesthetic to redcue any pain you may have after the operation.
After your operation
In the first day or so after your procedure, you may have an intravenous line ("drip") in place, a tube in your bladder ("catheter") and small tubes in your leg or back to allow infusion of local anaesthesia for pain prevention. You will have an oxygen mask in place at first.
Some pain is normal and does not mean anything has gone wrong and additional pain relieving medication may be taken intravenously or orally. After the first few days, you will usually manage with oral painkillers and, by the time you are ready to go home, no pain medication may be required. Ask your nurse for assistance if you do have pain after your procedure.
Initially, you will need assistance to get out of bed and you should call your nurse for assistance and support. Your nurse will guide you so that you can do as much as you can for yourself as soon as you are ready.
In the beginning, you will need to use a wheelchair to get around and it is best to get out of bed into a chair in the first day after your surgery if you can - but wait for assistance.
Recovery from surgery and getting ready to go home
After your surgery, you will be seen by specialists in rehabilitation inclduing physiotherapists, occupational therapists and a social worker. Your social worker can help with the psychological and emotional adjustment after amputation, and additional help can be arranged, if required.
Your physiotherapist will work on your mobility and provide you with some exercises for you to do on your own. When you are ready, they will work on increasing your independence and your mobility and having you ready for fitting with an artifical limb where this is appropriate.
Your occupational therapist will advise on any aids you might need including a wheelchair, adaptations to your home and other supports you might need. Your social worker will work with the OT on helping you or your family make applications for funding that might be required for structural changes in your home. Most patients can get back to their own home but if it is not suitable and/or cannot be modified, your social worker will help you explore other options.
Before you go home, you will have a review by a Consultant in Rehabilitation Medicine. They will work out if it will be possible for you to manage to use a prosthetic limb and will arrange an appointment for assessment in the NRH in Dun Laoghaire if this is the best option for you.
If yiou ar ready to leave the hospital before your home is ready, accomodation in a nursing home or rehabiliation facility may be arranged as a bridge to getting home.
Once your wound is fully healed (and this may not be until you are seen in the vascular outpatient clinic), you will be measured for an supplied with a compression stocking, specially chosen for your limb residium. This helps reduce swelling and prepare your residium for prosthetic limb fitting if this is appropriate for you. It should be worn every day, but taken off at bedtime.
Rehabilitation
Rehabilitation is an important part of the recovery process and, in most cases, this will be managed by the team in the NRH. As part of that process, you will be seen by a prosthetist who will arrange the supply of an artificial limb where this is possible.
It can take several months before you're fitted with a prosthetic limb (if you're suitable for a prosthesis), so you may need a wheelchair to help you get around if you've had an amputation of a lower limb.
Adjusting to life with a prosthetic limb takes a considerable amount of energy because you have to compensate for the loss of muscle and bone in the amputated limb.
Limb residium or stump care
It's very important to keep the skin on the surface of your residium clean to reduce the risk of it becoming irritated or infected. Gently wash your stump at least once a day (more frequently in hot weather) with mild unscented soap and warm water, and dry it carefully.
If you have a prosthetic limb, you should also regularly clean this as you have been shown in the NRH
Caring for your remaining limb
After having a leg or foot amputated, it's very important to avoid injuring your remaining "good" leg and foot, particularly if your amputation was needed because of diabetes. Your remaining leg and foot may also be at risk.
Avoid wearing poorly fitting footwear and ensure that an appropriately trained healthcare professional, such as a podiatrist, is involved in the care of your remaining foot. You should also be offered a regular review of your foot by a foot care team.
Complications of the surgery
Like any type of operation, an amputation carries a risk of complications.
Complications associated with having an amputation include:
- heart problems such as heart attack
- deep vein thrombosis (DVT)
- slow wound healing and wound infection
- pneumonia
- stump and "phantom limb" pain
Stump and "phantom limb" pain
Many people who have an amputation experience some degree of stump pain or "phantom limb" pain. Stump pain can have many different causes, including rubbing or sores where the stump touches a prosthetic limb, nerve damage during surgery and the development of neuromas.
Phantom limb sensations are sensations that seem to be coming from the amputated limb. Occasionally, these can be painful (phantom limb pain).
The term "phantom" does not mean the sensations are imaginary. Phantom limb pain is a real phenomenon, which has been confirmed using brain imaging scans to study how nerve signals are transmitted to the brain.
The symptoms of phantom limb pain can range from mild to severe. Some people have described brief "flashes" of mild pain, similar to an electric shock, that last for a few seconds. Others have described constant severe pain.
Stump and phantom limb pain will usually improve over time, but treatments are available to help relieve the symptoms. This may include medicines,physiotherapy and,sometimes, specialist procedures. In addition, adjusting the way your prosthesis fits to make it more comfortable may help.
Psychological issues include
- anxiety
- denial (refusing to accept they need to make changes, such as having physiotherapy, to adapt to life after an amputation)
- grief
- feeling suicidal
- People who've had an amputation as a result of trauma (particularly members of the armed forces) also have an increased risk of developing post-traumatic stress disorder (PTSD).
Talk to your doctor about your thoughts and feelings, particularly if you're feeling depressed or suicidal. You may need additional treatment, such as antidepressants or counselling, to improve your ability to cope after having an amputation.