Leg or foot amputation

Definition

Leg or foot amputation is the removal of a leg, foot or toes from the body. These body parts are called extremities. Amputations are done either by surgery, or they occur by accident or trauma to the body.

Alternative Names

Amputation - foot; Amputation - leg; Trans-metatarsal amputation; Below knee amputation; BK amputation; Above knee amputation; AK amputation; Trans-femoral amputation; Trans-tibial amputation

Description

Why the Procedure Is Performed

Reasons for having an amputation of a lower limb are:

• Severe trauma to the limb that is caused by an accident
• Poor blood flow to the limb
• Infections that do not go away or become worse and cannot be controlled or healed
• Tumors of the lower limb
• Severe burns or severe frostbite
• Wounds that do not heal

Risks

Risks for any surgery are:

• Blood clots in the legs that may travel to the lungs
• Breathing problems
• Bleeding

Risks for this surgery are:

• A feeling that the limb is still there. This is called phantom sensation. Sometimes this feeling can be painful. That is called phantom pain.
• The joint closest to the part that is amputated loses its range of motion, making it hard to move. This is called joint contracture.
• Infection of the skin or bone.
• The amputation wound does not heal properly.

Before the Procedure

When your amputation is planned, you will be asked to do certain things to prepare for it. Always tell your doctor or nurse:

• What drugs you are taking, even drugs or herbs you bought without a prescription
• If you have been drinking a lot of alcohol

During the days before your surgery, you may be asked to stop taking aspirin, ibuprofen (such as Advil or Motrin), warfarin (Coumadin), and any other drugs that make it hard for your blood to clot.

Ask your doctor which drugs you should still take on the day of your surgery. If you smoke, stop.

If you have diabetes, follow your diet and take your medicines as usual until the day of surgery.

On the day of the surgery, most times you will be asked not to drink or eat anything for 8 to 12 hours before your surgery.

Take your drugs your doctor told you to take with a small sip of water. If you have diabetes, follow the directions your doctor gave you.

Prepare your home before surgery:

• What help will you need when you come home from the hospital?
• Do you have a family member, friend, or neighbor who can help you? If not, ask your doctor or nurse for help planning for someone to come into your home.
• Is your bathroom and the rest of your house safe for you to move around in?
• Will you be able to get in and out of your home safely?

After the Procedure

The end of your leg, or stump, will have a dressing and bandage that will remain on for 3 or more days. You may have pain for the first few days. You will be able to take pain medicine as you need them.

You may have a tube that drains fluid from the wound. This will be taken out after a few days.

Before leaving the hospital, you will begin learning how to:

• Use a wheelchair or a walker
• Stretch your muscles to make them stronger
• Strengthen your arms and legs
• Begin walking with a walking aid and parallel bars
• Start moving around the bed and into the chair in your hospital room
• Keep your joints mobile
• Sit or lay in different positions to keep your joints from becoming stiff
• Control swelling in the area around your amputation
• Properly put weight on your leg. You'll be told how much weight to put on your leg. You may not be allowed to put weight on your leg until the stump is fully healed.

Fitting for prosthesis, a manmade part to replace your limb, may occur when:

• Your amputation wound is mostly healed
• Your stump is no longer tender to the touch

Outlook (Prognosis)

Your recovery and ability to function after an amputation depend on many things. Some of these are the reason for the amputation, whether you have diabetes or poor blood flow, and your age.

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References

Heck RK. General principles of amputations. In: Canale ST, Beatty JH, eds. Campbell's Operative Orthopaedics. 11th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap 9.