Amputation: What is it and How is it Done?

What is Amputation?

Amputation refers to the complete or partial removal of a part of the body that is covered by skin, such as the limbs – arms or legs. An amputation may become necessary to remove damaged tissues or crushed bone that may have occurred as a result of an accident, at the battlefield, or any other reason.

The affected parts are surgically removed, so the infection or gangrene does not spread to other parts of the body.

What is Amputation for?

The following are the instances under which an amputation surgery might be recommended by your surgeon:

• Peripheral arterial disease is the most common reason behind a surgical amputation. This medical condition involves inadequate blood circulation in either of your limbs as a result of narrowing of the arteries of the legs or arms, or total or partial damage of either of the limbs. The poor blood flow impedes the cells in the body from receiving oxygen and essential nutrition from the bloodstream, which are important for the smooth functioning of the limbs. The lack of oxygen may lead to infection and death of tissues.
• Cancerous tumour of the muscle or bone of the limbs
• Neuroma or thickening of nerve tissue
• Infection of the limbs that cannot be treated with antibiotics or any other treatment.
• Frostbite, a medical condition of the skin on a certain body part that was left uncovered in frosty and freezing temperatures
• Severe injury arising from a car accident or a burn

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What are the Risks of Amputation?

Some of the most prominent risks of a surgical amputation are:

• Blood clots in the arms or legs that may reach the lungs as a result of blood circulation
• Profuse bleeding from limbs
• Breathing problems
• Infection of the bone or skin where the surgery was undertaken
• The surgical wound does not heal entirely
• A sensation, known as the phantom sensation, that the amputated limb still exists. This leads to a sharp pain in an around the amputated area, referred to as the phantom pain.
• Joint contracture, or the joint that is at the closest proximity to where the amputation surgery was undertaken, loses its usual range of motion. As a result, it adversely affects mobility.

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How to Prepare for an Amputation?

There are certain ways in which you need to prepare yourself for an impending amputation, both physically and mentally. Here are some guidelines on how you can prepare yourself for an amputation as a part of the pre-surgical care:

• Inform your doctor about the over-the-counter (OTC) medicines, herbs, or supplements that you might be taking.
• Don’t take drugs like ibuprofen, aspirin, warfarin, and similar medicines that prevent the blood from clotting.
• Stop drinking and smoking if you have a habit of excessive drinking and smoking.
• Enquire about the medicines you may need to take on the day of the amputation surgery.
• Continue taking your medicines for diabetes till the day of the surgery.
• Take your medicines, if any, with a sip of water. In case you are a diabetic patient, abide by the instructions of your doctor.
• Remember to not drink or eat 8 to 12 hours before the amputation surgery or follow other specifications by your doctor.
• Make arrangements for a nurse or medical assistance that you might need after you return home after the surgery.
• Remove objects and barriers in your home on which you might trip, leading to accidents.

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What happens during an Amputation?

The procedure and severity of the surgery is determined by various factors:

• Part of the limb or arm being amputated
• Complications involved
• Your age and existing health – whether you are suffering from any medical conditions, etc.

Amputation can be undertaken under the influence of general anaesthesia, which is a medically induced sleep, or spinal anaesthesia, which numbs your body down from the waist. During the surgery, the damaged tissue from the affected limb is removed by the surgeon, leaving out on as much of the healthy tissue as possible.

A surgeon usually considers the following to decide the area of the limb to cut and portion of the tissue to remove.

• Checking the pulse in and around the part of the body where the amputation surgery will be undertaken.
• Evaluating the temperature of the skin of the body part that will be amputated and comparing it to the skin temperature of healthy limbs.
• Checking for areas with red skin.
• Checking the sensitivity of the skin of the body part that will be amputated.

Procedure for the surgery that is usually followed by the surgeon is:

• Remove the damaged portion of the tissue and crushed bone, if any;
• Smoothen jagged edges of crushed bone(s);
• Sew the nerves and vessels that have been amputated;
• Cut and shape muscles at the end of the amputated limb, called the stump, so that a prosthetic can be attached to it;
• The surgeon may decide to undertake a closed amputation, wherein the skin flaps of a surgical wound may be either sealed. Alternatively, he/she may decide to not seal the wound, so that additional tissues may be opened if needed;
• A sterile dressing is placed on the surgical wound and then a stocking is placed to hold drainage tubes and bandages together;
• Your limb may be held in place with a splint or in a traction.

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What is the Recovery Period for Amputation?

• Initially, the medical staff at the hospital changes the dressing on the wound and gradually you will be guided to do the dressing and change it yourself.
• Medical conditions like diabetes may interfere with your healing process and are closely monitored.
• Physiotherapy and other exercises like stretching exercises start a few days after the surgery.
• Prosthetics may be installed about 10 to 14 days after surgery.
• The healing process usually lasts between 4 to 8 weeks, depending on the severity of the surgery and other health conditions that you may be suffering from.
• Emotional recovery takes longer than physical recovery. In case of phantom pain, or the sensation that the surgically removed limb still exists, therapy or medication may be recommended for effective recovery.

Patient Care and Management: Post-surgical Care for Amputation

Expectedly, you will be experiencing pain in and around the area that has been surgically amputated. The amputated area will be dressed and bandaged for 3 days and more, as per the discretion of your surgeon. He/she will also possibly install a tube to draw and dispose of the waste fluid from the surgical wound. You will also probably be prescribed painkillers and antibiotics.

Here is a list of things that will be a part of your post-surgical care:

• Use a wheelchair or a walker in case of total or partial amputation of either or both your legs.
• Take special care when exercising, as advised by your medical professional. Those exercises are meant to strengthen the muscles of the limbs and bring back flexibility to your bones, making them functional gradually.
• While still at the hospital, gradually start making an effort to move around with a parallel bar or walking aid around your hospital room if your doctor allows.
• Frequently change sides when on the bed to prevent your joints from becoming rigid.
• Follow the medications prescribed to control pain and inflammation in and around the surgical amputation.
• Follow the instructions regarding when and how much weight you should exert on your residual limb or amputated arm. You may be advised not to put weight on the amputated area till it has healed completely.
• In case you have been advised prosthesis as a replacement for your amputated limb, it will be fitted when the amputated area has healed completely and the area around it is not tender to touch.

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