What is amputation?

An amputation is a procedure where a surgeon removes a limb, or part of a limb, that is no longer useful to you, is causing you great pain, or is threatening your health because of extensive infection. Most commonly, a toe, foot, leg, or arm is amputated.  

The most common reason an amputation may be needed is  peripheral arterial disease (PAD) due to atherosclerosis (hardening of the arteries).  In PAD, the blood vessels in your limbs become damaged because of hardening of the arteries or diabetes.

Your body's cells depend on a constant supply of oxygen and nutrients from your blood. If your blood vessels are unable to deliver adequate amounts of blood and oxygen to your fingers or toes, the cells and tissues die and are vulnerable to infection. Extensive tissue death may require amputation.

How do I prepare for an amputation?

Physicians consider amputation a last resort.  Your physician will perform a physical examination to decide whether you need an amputation. He or she will check for:

• Fever
• Cool skin near your wound
• Extremely painful skin
• Wound odor
• Infected or non-healing sores or wounds

Your physician will also order tests to see how well blood is reaching your limbs. These tests may include:

• Angiography
• Duplex ultrasound
• Blood pressure tests

If you have other conditions, such as diabetes, high blood pressure, heart problems, poor kidney function, or infections, your physician will discuss appropriate treatment. He or she will also test your physical strength, balance, and coordination.

If you are going to use an artificial limb, your physician may measure you for the device before your operation so it will be available as soon as you recover.

• You may receive counseling before your surgery to help you adapt to the loss of your natural limb.

• Your physician will discuss with you whether to reduce or stop any medications that might increase your risk bleeding or other complications.

• If you have any allergies to anesthesia, pain medications, or antibiotics, you should tell your physician at this time.

When do I need amputation?

• Most people who require an amputation have PAD, a traumatic injury, or cancer.

• PAD is the leading cause of amputation in people age 50 and older, and accounts for up to 90 percent of amputations overall.

• Normally, surgeons treat advanced PAD through other methods, like draining any infected tissue or performing surgery.

• However, if these treatments do not work, amputation will remove a source of major infection and may be necessary to save your life.

• A traumatic injury, such as a car accident or a severe burn, can destroy blood vessels and cause tissue death.

•  As a result, infection can spread through your body and threaten your life. Your medical team will make every effort to save your limb by surgically replacing or repairing your damaged blood vessels or using donor tissue.

•  However, if these measures do not work, amputation can save your life. Traumatic injuries are the most common reason for amputations in people younger than age 50.

• Your physician may recommend amputation if you have cancerous tumors in your limbs. You may also receive chemotherapy, radiation, or other treatments to destroy cancer cells. These treatments can shrink the tumor and increase the effectiveness of your amputation.

Am I at risk for complications during amputation?

Like any surgical procedure, there is always associated risk. If you have other conditions, such as diabetes or heart disease, there is an increased risk of complications from an amputation. Having a very serious traumatic injury also increases your risk of complications.

•  Above-the-knee amputations can be riskier than below-the-knee amputations, because people who receive above-the-knee amputations are more likely to be in poor health.

What happens during amputation?

To perform an amputation, your physician must remove your diseased limb but preserve as much healthy skin, blood vessel, and nerve tissue as possible. Choosing the incision site is important. If your surgeon removes too little tissue, your wound will not heal because unhealthy tissue remains.

To determine how much tissue to remove, your physician will check for a pulse at a joint close to the site. He or she will also compare the skin temperatures in the diseased limb with those in a healthy limb, and note places where the skin appears red, since an incision made through reddish skin may be less likely to heal.

• Your physician will also check that your skin around the proposed incision point still has sensitivity to touch.

• Finally, after he or she makes the initial cut, your physician may decide that more of your limb needs to be removed if the edges of your skin do not bleed enough to allow them to heal.

• Before the procedure begins, your anesthesiologist will put you to sleep or numb your body below the spine.

• You will be connected to machines that monitor your heart rate, blood pressure, temperature, and brain function.

• Your surgeon then cuts into your skin, leaving enough healthy skin to cover your stump for better healing.

• When your surgeon then cuts through the muscles, he or she may either sew them to the bone, or shape them, to make sure that your stump has a comfortable contour for your artificial limb.

• Your surgeon also divides and protects your nerves, so that they are not exposed and painful.

• During your surgery, clamps are applied to minimize bleeding when the surgeon divides the healthy major blood vessels.

• Before finishing your amputation, your surgeon will stitch the vessels, and then release the clamps to ensure that all bleeding points are secure.

• If you have a traumatic injury your surgeon will remove the crushed bone. Your surgeon then will smooth the uneven areas of your bone to prevent pain once you receive your artificial limb.

• If necessary, your surgical team may then install temporary drains that will drain your blood and other fluids.

• When your surgeon has completely removed all of the dead tissue, he or she may decide to leave the site open (open flap amputation) or to close the flaps (closed amputation).

•  In an open flap amputation, your skin remains drawn back from the amputation site for 10 to 14 days so your surgical care team can clean off of any questionable or infected tissue.

• Once the stump tissue is clean and free of infection, the skin flaps are sewn together to close the wound. In a closed amputation, the wound is sewn shut immediately. 

• A closed amputation is usually done if your surgeon is reasonably certain that the chance of infection is small. 

• Your surgical care team may place a stocking over your stump to hold drainage tubes and wound dressings, or your limb may be placed in traction, or a splint, depending upon your particular situation.

What can I expect after amputation?

• After your surgery, you will stay in the hospital for approximately 5 to 14 days, depending upon your particular situation.

• Your physician may teach you how to change your wound dressings, or the hospital staff will change them for you. Your physician usually checks the progress of your wound in about 7 to 10 days.

• Your physician will also monitor any conditions you have that might slow your healing, such as hardening of the arteries or diabetes. If you need pain medications or antibiotics, your physician will prescribe them. Ideally, your wound should fully heal in about 4 to 8 weeks after your surgery.

• If your condition permits, ideally, you will receive physical therapy soon after your surgery.

• Physical therapy includes gentle stretching for the first 2 or 3 days.

• Later, you will perform exercises, such as getting in and out of your bed or in and out of your wheelchair.

• Eventually, you will learn how to bear your weight on your remaining limb.

• Depending upon your particular situation, you may also begin to practice with your artificial limb as early as 10 to 14 days after your surgery, but this depends upon your comfort and wound healing progress.

• You may experience phantom pain (a sense of feeling pain in your amputated limb) or other emotional concerns, such as grief over the lost limb, after surgery. If this is the case, your physician can recommend counseling or drug therapy, as appropriate.

Are there any complications?

You may have complications following any surgical procedure. Complications that occur specifically from amputation include:

• Joint deformity called contracture
• Severe bruise called a hematoma
• Death of the skin flaps (necrosis)
• Wound opening or infection

Your surgeon or physician can treat all of these complications. In rare instances, further surgical treatment or another amputation is needed.

What can I do to stay healthy?

If your wound has healed well and your artificial limb fits properly,  your amputation should cause you no long-term medical concerns.  However, if you have PAD, amputation does not stop plaque from building up. To prevent hardening of the arteries from affecting other parts of your body, including your heart, consider the following lifestyle changes:

• Eat more foods low in saturated fat, cholesterol, and calories
• Exercise regularly
• Maintain your ideal body weight
• Avoid smoking

You can learn how to adapt to having an artificial limb, including getting regular exercise, with the help of a physical therapist.  Studies have found that amputees who engage in regular physical exercise feel better about themselves than those who are more sedentary.