When you have a blockage or narrowing of the arteries that supply your legs, blood flow to your legs will decrease. You may have developed pain in your foot or feet that wake you up at night, ulcers, or black areas on your toes, feet, or legs.
If severe arterial disease is left untreated, the lack of blood flow leads to an increase in pain. Tissue in the leg dies from lack of oxygen and nutrients, which leads to infection and burns. In some cases, burns can be very dangerous as the infection can spread throughout the body and become life threatening.
Amputation is always a last resort and is only recommended if your surgeon has determined that there is no other way to improve blood flow.
The main amputation sites are:
Right below the knee
Through the knee
Through the thigh
The location of the amputation will depend on how poor the blood supply to your leg is. If possible, amputations are done below the knee as it is easier to walk with an artificial limb after the operation. However, many people are fine after a thigh amputation. The following information will help explain the leg amputation procedure:
Before your surgery
You will usually be taken a day or two before your surgery. You will be taken to your bed by one of the nurses. Who will also record your personal information on your medical records.
A series of tests will need to be done to make sure you are eligible for the surgery. This contains:
X-ray of the arteries (arteriogram) to confirm where the blockages are
Chest x-ray
Blood tests
EKG (a heart tracking)
Alcohol test
Please bring any medication you are currently taking with you.
You will be visited by the surgeon who will perform your surgery and also the doctor who will give you the anesthetic. You decide where on the leg the amputation should take place. If you have any questions about the operation, please contact the doctors.
The operation
You will be given general anesthesia in the anesthesia room so that you can fall asleep better. Alternatively, you can have a tube inserted into your back through which pain medication can be given to numb the lower half of your body while you stay awake (spine or epidural). The anesthetist can use both an epidural and general anesthetic to provide pain relief after your surgery.
While you sleep, tubes will be inserted into your bladder to drain your urine and into a vein in your arm or neck (or both) to take blood pressure readings and to give you fluids after surgery.
The amputation stump is often closed with a prick under the skin that dissolves on its own, and occasionally with a small tube to drain any fluid that may develop. A clear plastic bandage can be used to allow inspection of the stump, but bandages or a plaster cast are sometimes used.
After the operation
You will usually return to the ward once you have recovered from the anesthetic. Sometimes the anesthetist decides to send you to the Post-Operative Surgical Unit (POSU) or High Dependency Unit (HDU) so they can more closely monitor your progress.
You can get fluids from a drop in one of your veins until you are good enough to sit up and take fluids and food by mouth. The nurses and doctors will try to keep you pain free by giving pain medication by injection, through a tube in your back, or through a machine that you can control yourself at the push of a button.
It is common to experience pain that feels like part of the distant leg (phantom pain). This can be treated with medication and will go away quickly. You may also need a small blood transfusion.
As you recover, the various tubes will be removed and you will gradually become more flexible until you are fit enough to go home.
Before and after your surgery, you will be visited by a physical therapist who will help you breathe (to prevent you from developing a chest infection) and help you move around. You will first be shown exercises in bed and then you will be asked to get off your bed and into a chair.
While your wound is healing, the physical therapist will guide you on a temporary artificial limb, if you feel you are wearing one. If not, learn how to use a wheelchair.
You will also be visited by an occupational therapist who will help you with your rehabilitation. Even if you plan to walk, you may need a wheelchair temporarily or for long trips.
An appointment will be made for you to place an artificial limb in the middle of the limb that will look like your other leg when put on.
Losing a limb can be extremely stressful. If you think you need additional assistance or can speak to someone, please contact your GP or the Douglas Bader Foundation for more information.
Go home
Some changes in your home may be required before you are laid off, and in some cases you may need to move to different accommodation. When you leave the hospital, you will still need to go to physical therapy to gain independence with your artificial limbs or wheelchair.
If your sutures need to be removed and they did not do it in the hospital, the district nurse will visit you and examine your wound as well.
Nowadays people walk on artificial limbs very well, and you can walk again provided you have the motivation and fitness to do so. You will be assisted by the physical therapists, nurses and doctors at the Limb Adaptation Center.
Driving: May be possible with an amputation either with an automatic car or with some special modifications. Bathing: You can take a bath or shower once your wound is dry, but you will likely need help first. You may also need handles or a hoist to get in and out of the bathtub safely.
Complications
Due to poor blood supply, wound healing can sometimes be slow and occasionally another amputation higher up the leg is required if the wound does not heal.
The wound can become infected and must be treated with antibiotics in this case.
Pain in the wound is common and can last for several months.
Breast infections can occur after this type of surgery, especially in smokers, and may require antibiotic treatment and physical therapy.
As with any surgery, there is little risk of a heart attack or stroke, or even death, as a result of the surgery.
What can i do to help myself?
If you have been a smoker before, you must make sincere and determined efforts to quit as it can damage the circulation in your other leg.
It is also important that you do not put on weight, as this will make it difficult to mobilize with a wheelchair or artificial leg. Eat lots of fresh fruits and vegetables.
Take good care of the rest of your foot. Keep it clean and safe from injury by wearing well-fitting shoes. The orthopedic surgeon can provide special footwear and a podiatrist can cut your toenails if necessary.
If you are a diabetic, it is a good idea to monitor your blood pressure as it is extremely important for your overall rehabilitation and future health.