Limb Amputation: Reasons, Procedure And Recovery

Wellness

oi-Devika Bandyopadhya

By Devika Bandyopadhya

Tuesday, April 9, 2019, 11:41

The loss of a limb (amputation) is a life-changing experience. It's an extreme physical loss and is emotionally devastating (especially when it is sudden and one is not prepared for it). The way one deals with this loss is quite dependent on the character and attitude of the person. It is important for the person to realize and accept the truth. A caring friend or a mental health professional ^[1] can be of great help at this stage. One is able to lead a happier life when he or she is able to accept the new physical image.

It might be of great importance to know the reasons involved behind limb amputation, the procedure involved and the aftercare that the patient requires.

What Is Limb Amputation?

Amputation is the surgical removal of all or part of a limb (arm, leg, foot, toe, hand or finger). The most common amputation surgery is the amputation of the leg ^[2] (either above or below the knee). Amputation can be done to treat disease, injury or infection. It can also be done in order to remove tumours from muscles and bones ^[3] .

Reasons For Limb Amputation

The most common reason behind amputation is poor circulation that leads to narrowing or damage of arteries (known as a peripheral arterial disease). When there is lack of proper/adequate blood flow, the cells are unable to get oxygen and nutrients which they need from the bloodstream ^[4] . This leads to the affected tissue dying causing infection. This issue occurs mostly between the ages of 50 to 75.

The following are some of the other possible reasons for amputation ^[5] :

• Presence of cancerous tumour in the muscle or bone of the limb
• Thickening of nerve tissue (neuroma)
• Severe injury (for instance, due to a vehicle accident or serious burn)
• Severe infection that does not heal with antibiotics or other treatment options
• Frostbite

Preparing For A Limb Amputation

Outlined below are some of the common steps that you might be asked to follow prior to amputation. However, always talk to your surgeon beforehand and seek his or her guidance on the dos and don'ts.

• You will be asked to sign a consent form ^[6] . Read the form carefully before signing and ask questions if you have any doubt.
• Apart from getting to know your complete medical history, your doctor might also want you to undergo a physical examination to ensure that you are otherwise healthy.
• Mostly you will be asked to fast for 8 hours before the surgery ^[7] .
• In case you are pregnant or feel you might be, please inform your surgeon.
• The surgeon should be informed about any sensitivity or allergy issues (especially with medication) that you might have. In some rare cases, patients might be allergic to tape, latex, local and general anaesthesia ^[8] .
• Inform your surgeon about all the medicines that you are currently taking along with herbal supplements if any.
• Inform the surgeon if you have had any past history of bleeding disorders.
• The surgeon should be informed about any blood-thinning medicines that you might be taking. You might need to stop these medications prior to the surgical procedure.
• A sedative might be given for you to relax.

The Limb Amputation Procedure

After the surgery, you would most likely stay in the hospital for about 5 to 14 days (sometimes more) depending on the complications post-surgery ^[9] . The surgical procedure itself may vary depending on the limb (or extremity) being amputated along with the patient's general health condition.

The amputation could either be done under general anaesthesia or spinal anaesthesia (numbs the body from the waist down). During the amputation procedure, the surgeon would remove all the damaged tissues leaving only as much healthy tissue as possible ^[10] .

The following are the methods that a surgeon follows to determine where to cut and how much tissue to remove ^[11] :

• Comparing the skin temperature of the affected limb with a healthy part of the limb
• Checking for a pulse close to the region where a cut is being planned
• Looking out for regions that show visibly reddened skin
• Checking the site of cut to see if it is still sensitive to touch or not.

The following is performed by the surgeon during the amputation procedure ^[12] :

• Smoothening the uneven areas of bone
• Removal of diseased tissue and any crushed bone
• Sealing blood vessels and nerves
• Cutting and shaping muscles so that the stump (end of the remaining limb) can be considered for an artificial appliance (prosthesis).

When the wound is closed right away by sewing the skin flaps it is called closed amputation. This is done if there is minimal risk of infection. The surgeon may also choose to leave the site open for several days. This is called open flap amputation. This is done so that any infected tissue can be cleaned off. Once the stump tissue is free of infection, the skin flaps would be sutured together to close the wound ^[13] .

What To Expect After A Limb Amputation

• In the hospital

Once the procedure is done, you will be taken to a recovery room. You will be under constant monitoring. The blood flow and feeling of the affected extremity will be regularly checked. Once the patient's pulse, blood pressure and breathing is stable, he or she will be moved to the hospital room ^[14] . The dressing is regularly changed and the patient will be put on antibiotics and pain medicines.

Physical therapy is started soon after surgery ^[15] . The rehabilitation processes involved might include gentle stretches or special exercises depending on the patient's condition. In case of a leg amputation, the patient is trained on how to bear weight on the remaining limb ^[16] .

An artificial limb can be used as soon as the wound shows good signs of healing. A prosthetist would be able to help the patient with the fitting of an artificial limb ^[17] .

The patient will be discharged from the hospital once the wound has healed to a great extent and also only after he or she is able to take personalized care with minimum assistance.

• At home

It is important that you sincerely follow all the instructions given by your doctor. You would have received detailed instructions about how to care for the surgical site, bathing, activity levels, dressing changes and physical therapy. Continue taking the prescribed pain relievers for soreness.

Approach your surgeon immediately in case of any of the following ^[18] :

• Increased pain around the amputation site
• Numbness or tingling sensation in the remaining limb
• Fever or chills
• Redness or swelling around the site of the incision
• Bleeding or leakage of other fluid from the incision site

You may continue with a normal diet (unless advised differently).

• Long-term care

Keeping in mind the immense advances that have been made in the fields of surgery, rehabilitation and prosthetic design, proper healing and fitting of an artificial limb can help in the reduction of risk associated with post-surgery complications.

If the amputation was a result of peripheral artery disease, then your doctor would need to intervene further to ensure that the condition does not affect other parts of your body. The following lifestyle changes might be advised ^[19] :

• Stop smoking
• Maintain a regular exercise regime
• Maintain a healthy diet (low in saturated fat and cholesterol)
• Work out towards maintaining ideal body weight

The Need For Physical Therapy

A necessity that is most of the time ignored is the need for physical therapy after the amputation. Although, it is highly likely that a person who has just lost a limb will be extremely depressed and for him or her to indulge in physical therapy can be quiet a task, it is definitely worth the effort. Even though it is hard work, therapy loosens the residual limb and increases muscle tone and coordination. With continuous physical therapy, your joints will remain flexible. With this, you would also get a better understanding of how to use your prosthesis properly alongside carrying out your daily activities ^[20] .

Risks Of Limb Amputation

Above-knee amputations are riskier than below-knee amputations ^[21] . People with the following are at a higher risk of complications from amputations compared to others ^[22] :

• Heart diseases
• Diabetes
• Any infection

The complications associated with amputation could be as follows ^[23] :

• Wound opening
• Tissue death
• Joint deformity
• Haematoma (a bruised area with blood that gets collected under the skin)
• Infection
• A blood clot in the deep veins in the limb

Preventing Limb Amputation

If you are currently suffering from a severe, chronic wound and believe that amputation will most likely be the next step, then you need to reconsider your belief. Amputation is not always a necessity. However, it is also true that the doctor knows best and if you have been advised to go ahead with an amputation, then that is definitely the best choice for you and your medical condition. Nevertheless, if you would want to lower the chances of you undergoing an amputation procedure, then consider doing the following:

• Indulge in a good wound care routine.
• Ensure that your wound is free of infection ^[24] (this is the best way to prevent an amputation)
• Always keep ample stock of wound care supplies so that you can easily perform wound care at home.
• In case you are unable to do everything on your own, hire a medical help.
• In case you suffer from diabetes, you would need to regularly keep checking your feet and leg for diabetic ulcers ^[25] .
• People should follow a lifestyle that can ensure proper maintenance of blood sugar levels (this would help in avoiding neuropathy and keep circulation healthy, especially for people with diabetes).