Why might an amputation be needed?

Most amputations in Australia are done because the arteries in the legs have become blocked and there is not enough blood getting to the limb. This can be a complication of diabetes, high blood pressure, smoking or kidney failure.

Diabetes is the most common reason people need an amputation in Australia. However, most of these amputations could be prevented. If you have diabetes, it is very important to look after your feet. FootForward is a program designed to help people with diabetes understand the importance of getting their feet checked.

An amputation may also be needed if the limb:

• has a severe infection
• is affected by gangrene
• is affected by cancer
• has been seriously injured — for example by being crushed
• is deformed or doesn’t move or function properly

Sometimes only a finger or toe or part of the hand or foot is amputated (known as a minor amputation). Major amputations involve removing the foot, part of the leg — usually below or above the knee — or an entire arm.

The type of amputation a person might need usually depends on how well the wound is likely to heal. If the blood supply is very limited, it may not be possible for the tissues to heal even after a minor amputation, so a major amputation may be the best option.

Preparing for surgery

Amputations can be done as emergency or elective (planned) surgery. Before planned amputations, you will meet with the surgeon to discuss which operation is best for you.

You will have a thorough medical examination and psychological assessment. Your healthy limb will be assessed since it will have to carry extra strain or duties after the operation. You will also be advised on any adaptations you may need to make at home or work. Physiotherapy will be planned to help with your rehabilitation after the operation.

During the surgery

You will have either a general anaesthetic (where you go to sleep) or for amputations involving legs and feet an epidural (where the lower half of your body is completely numbed but you are still awake).

The surgeon will remove the limb, or part of the limb, and may then smooth off the remaining bone. The wound will be closed with stitches or staples. A drain may be inserted under your skin to drain away excess fluid. The wound will be covered with a bandage for a few days to prevent infection.

What can go wrong?

An amputation is major surgery. Possible risks include:

• heart problems, such as a heart attack
• deep vein thrombosis (DVT)
• slow wound healing or infection of the wound
• pneumonia
• stump and 'phantom limb' pain
• pressure sores

Older people and people with hardening of the arteries are more at risk of serious complications, including death. Your surgeon will discuss all of these risks with you before you consent to the operation.

After the operation, some people develop contractures. These are where the muscles, skin, tendons or ligaments become stretched and stiff, limiting how you can move. The more you move and exercise, the less likely you will be to develop a contracture.

Managing pain

The wound will be sore after surgery, but this should start to ease in 2 to 5 days. Tell the care team if you feel you need more pain killers.

Many people report 'phantom limb' pain. They feel pain in the amputated limb, even though it is no longer there. This pain is usually mild and goes away by itself. But in some patients, it can become a serious problem that is hard to treat. If this happens, you may need medicines designed to treat nerve pain combined with a range of other therapies.

Rehabilitation

You will be fitted with a compression garment around the stump to help with swelling. You will need to wear this every day and take it off at bedtime. Make sure you wash your compression garments regularly and follow your medical team’s instructions to look after the stump.

Your physiotherapist and occupational therapist will work out a rehabilitation program to help you return to work and other activities. The program will start a few days after surgery and will help you manage independently, for example by teaching you how to get in and out of a wheelchair. You may then progress to an exercise program and learn how to use your prosthetic limb if you have one.

Prosthetics

You may be able to have a prosthetic (false) limb fitted sometime after surgery. Using a prosthetic limb can be hard work and you will need a lot of preparation, physiotherapy and rehabilitation. Prosthetic limbs may not be suitable for people who are very frail or who have a serious health condition.

Life after an amputation

Amputation can affect every area of your life, including your home and work. It is a lot to adapt to, and you will need support.

You may need modifications to your home, or equipment such as a stair-ramp, handrails, or a wheelchair lift. You will likely have to change your routines and find new ways to do the things you are used to doing. However, with the right help, training and equipment, you will be able to enjoy a good quality of life. The healthier and fitter you are, the easier it is to adapt.

Amputation can also have a significant effect on mental health. For some people, losing a limb is like losing a loved one and they will need to grieve. Coming to terms with the psychological impact of an amputation is as important as coping with the physical changes.