Volume 2, 2002

First Step - A Guide for Adapting to Limb Loss, A publication of the National Limb Loss Information Center


Lower Extremity

by Raymond Francis, CP

Is amputation really necessary?

During the course of treatment to try to save your leg, your doctor probably told you that amputation was a possibility. Such a statement was not meant to scare you – it was made to prepare you for one of the various outcomes that might result. Now that the prospect of amputation is becoming a reality, you may feel as though you should be depressed that you are losing your leg. In reality, though, amputation is giving you image: doctor explaining to patienta chance to remove something that is seriously threatening your health. Your doctor will try as hard as possible to save your leg, but when the treatments are not working, then it’s time to save your life instead of your leg.

Think of it this way - your leg is no longer working for you the way it should, so it’s time to say goodbye to an old friend that’s no longer able to help you. In many cases, an amputation that is performed well, followed by a good prosthetic fitting, will result in less pain and more function for you. If you have ulcers that won’t heal, or some other condition that is causing you pain with every step you take and is preventing you from living the life that you want to live, then having an amputation is taking a step toward improving the quality of your life – a very positive thing indeed.

How much of my leg will be removed?

One thing that is important to understand is that there is no set place on a leg to conduct the amputation. Your condition is unique, and, therefore, your surgeon will need to determine the best place on your leg to amputate. Ideally, the part of the leg that remains (the "residual limb") should be as long as possible. A longer residual limb gives you a better lever with which to control your prosthesis; however, the surgeon also wants to make sure that there is enough blood flowing to the amputation site to ensure adequate healing. There’s no point in leaving you with a nice long residual limb if it doesn’t heal properly. You’ll simply end up back in the hospital for more surgery. Therefore, the surgeon will have to make a compromise between achieving the longest possible residual limb, yet amputating high enough on the leg to make sure that the amputation site will heal properly.

Before your amputation, ask your doctor how he or she will determine where on the leg to amputate. One method is for the doctor to actually make a small incision at the desired amputation site as the surgery is about to begin, and then wait to see how well the blood flows. If the blood flow is insufficient for proper healing, then the doctor can make another small incision a little bit higher on the leg and check the blood flow again, repeating the procedure until adequate blood flow is located. You can be fitted with a prosthesis if you have a residual limb of almost any length, so the surgeon’s goal should be to achieve the best combination of limb length and proper healing for you.

What can I expect once I go into the hospital?

Once your doctor decides to amputate, you should be able to check into the hospital very soon unless there is some other condition like high blood pressure, diabetes, or a heart condition that must be addressed first.

image: patient checking in to hospitalShortly before surgery, you will receive a sedative in your hospital room to help you rest and be calm. Then you will be transported on a gurney to the surgical suite, transferred to the operating table, and anesthetized. Once you enter a state of painlessness, the surgery will begin. As the procedure ends, the surgeon will insert a tube to allow fluids to drain out of your residual limb.

Once the operation is complete (after approximately one to four hours, depending on your condition), you will be transferred back on to the gurney and rolled into the recovery room. There the recovery team will administer pain medication and monitor your condition closely. After a couple of hours, you will be returned to your room.

When you wake up, you may feel as if your amputated leg is still there and that the amputation was not performed. I’ve even seen an instance where a visitor sat on the edge of a patient’s bed (where the leg would have been), and the patient said, "Hey, get off my leg!" as if the leg were actually there. This phenomenon is known as "phantom sensation." Some patients are embarrassed to ask about this feeling – fearing that the doctor will think they’re crazy. It is perfectly okay to ask your doctor about it, and rest assured phantom sensation will dissipate over time.

Within the first 24 hours after surgery, the drain tube will be removed from your limb. Also, you will probably be visited by a physical therapist during that first day. He or she will review a plan for your rehabilitation, and then will continue to visit you during your stay. The amount of therapy activity will increase with each visit according to how much you can tolerate.

The surgical dressing will be changed within the first 48 hours. The dressing may be changed daily during your stay, usually when the surgeon visits you to examine the site for signs of healing. Above-knee amputees typically heal a little more quickly than below-knee amputees, simply because an above-knee amputation occurs higher on the leg, where the blood vessels are larger. More blood flow equals better circulation, which leads to faster healing.

At some point during the first three to five days, you will be taken off intravenous drugs and started on oral pain medication. During this time, the surgeon has probably been discussing your condition with a prosthetist, the person who will eventually fit you with your prosthesis when you have healed sufficiently. The prosthetist will typically apply a shrinker, a compressive device that could be anything from an elastic bandage to something more sophisticated. The purpose of the shrinker is to keep swelling down, to facilitate circulation, and to prepare your limb for prosthetic fitting. The shrinker is typically changed a couple of times a day.

Within seven to 10 days, the average patient is ready to head home. The length of stay could be longer if you have a heart problem or some other condition that could slow your recovery time. It is, of course, in the hospital’s best interest to allow you to stay until you are adequately recovered. Otherwise, you might very well end up right back in the hospital.

image: woman in hospital bedWill I be in a lot of pain?

You will probably experience less pain than you might expect. The scenes we’ve all seen in movies where the patient bites down on a bullet and swills a bottle of whiskey to dull the pain of an amputation are a thing of the past. There have been significant advancements made in pain management during the past several years, resulting in very effective (yet less addictive) pain medication.

How will I be able to get around after my amputation?

After the surgery, your medical team will try to get you up and about as soon as possible (with their assistance, of course). They aren’t trying to be cruel by "kicking you out of bed." They’re simply trying to prevent fluid from building up in your lungs, which could lead to complications such as pneumonia. This means that you can actually use the restroom instead of the bedpan, which is something that you will certainly appreciate.

Before you leave the hospital, the physical therapist will show you how to get around with crutches, a walker or a wheelchair. Below-knee amputees probably won’t need a wheelchair, unless they are very weak or have a heart condition. Above-knee amputees may require one early on, simply because the function and maneuverability of the knee is no longer there.

After you receive your prosthesis and complete your physical therapy (assuming there are no other complicating health conditions), you should be able to return to your regular daily activities such as driving a car and going to work.

How soon will I be able to start wearing a prosthesis?

Again, this depends on your particular condition. In the best case, you could be fitted with a temporary prosthesis while you are still in the hospital. Conversely, it could take a month or longer after your amputation. It all depends on how quickly the amputation heals. The process of determining when you are ready to be fitted for your prosthesis is covered in an article on page 34. [Web Note: See Section 2 - Are You Ready For A Prosthesis]

No two patients (and therefore no two amputations) are exactly alike, so it’s hard to tell you exactly what your particular amputation experience will be like. Your experience may even vary depending on where you live, because typical treatment protocols tend to be different in various parts of the country. The important thing to know is that it is okay to ask questions of your medical team. Your doctor may have performed this procedure a hundred times, and your prosthetist may have fitted a hundred prosthetic limbs, but this is your first time as an amputee. You are entitled to understand what’s happening to you.

Author: Raymond Francis, CPAbout the Author:

Raymond Francis, CP, is a certified prosthetist with over 30 years experience. His patients have included amputees of all ages and activity levels ranging from older, less-active amputees to active-duty military. He is the chief prosthetist for Ohio Willow Wood and works extensively on research and product development.


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