The word \”amputation\” is the medical term that usually refers to the removal of a whole or part of an arm or a leg. Vascular surgeons only rarely performed amputations of the hands or arms but more frequently are faced with the task of removing toes or legs. Interestingly, it is one of the oldest surgical procedures identified from over 2000 years ago.
For the most part, the most common reason for amputation of the legs, below the knee, is because the arteries of the legs were blocked secondary to peripheral vascular disease or atherosclerosis. Individuals with diabetes suffer from both of these conditions and must be diligent in their care of their feet and legs.
A blockage in the arteries will result in a lack of blood supply to the tissue which then causes a slow death of the tissue. This death can appear as an open sore, ulceration or even dry gangrene. Less commonly, serious accidents will lead to the loss of the lower extremity as can the development of a tumor or cancer.
Amputation can be performed using two different surgical techniques. At this point there is no proven advantage for one technique over the other. The surgeon will make his decision based upon the amount of skin damage done above the ankle and how much of the leg will need to be amputated. When the lower extremity is amputated surgeons want to leave approximately 12 to 15 cm below the knee joint to produce a good-sized stump to which a prosthesis can later be fitted.
A below the knee amputation will affect individuals in different ways. The loss of the limb is a very personal issue and many people go through a grieving process before they are fully able to accept their new body image. The body is physically and permanently altered which will change the way in which the individual will be able to do their daily activities.
However, there are virtually no activities that a person with an amputation can not perform without the correct training and equipment. The most important objective in the rehabilitation of any individual is the ability to walk again. This process may be much more difficult in an elderly person then any young person but regaining the ability to walk is a major achievement which often times enables the individual to more fully accept the loss of their leg.
Researchers have found is that those individuals who had poor preoperative mobility were less likely to be able to walk following an amputation than those who didn\’t. This means that individuals who are over the age of 70, suffered from dementia or severe kidney and heart disease made it less likely that they would walk following their amputation than those individuals who were not faced with those same challenges.
Prior to surgery the surgeon and rehabilitation team will work with the individual to help them understand what will happen both directly before surgery and after surgery. As in all cases, there are risks with surgery. Individuals who undergo below the knee amputation may get an infection, have difficulty with blood clots or may have a collection of blood called hematoma that form under the incision.
Following the surgery there may be complications with pneumonia, angina, heart attack or stroke. Because mobility is restricted, pressure sores can also develop. Complications on the amputated leg may consist of infections or a failure to heal at the incision site. When this happens it may mean further operation to revise the amputation or to remove more of the leg.
Individuals who undergo below the knee amputation may also experience phantom limb pain. This is the sensation of being able to feel the amputated limb even though it isn\’t there. Most amputees will experience the sensation but the intensity will vary from person to person.
There are several layers of stitches which hold the incision together. While these can get wet in the shower, individuals should not swim or take a tub baths and should dry the incision area as soon as they leave the shower. Unless your primary care physician or surgeon has indicated otherwise, the incision should be left open to air in order to encourage healing. These stitches may be removed before you leave the hospital or on your first clinic visit back.
Individuals who have a below the knee amputation should evaluate their incision and leg twice daily and notify their physician if there is an increase in redness at the site or if there are red streaks on the skin. Any increased warmth, pain or bulging or swelling at the site is another reason to call the doctor. Individuals who notice new drainage or bleeding from the site, open spots between the stitches or have a temperature of greater than 101.5 may be experiencing an infection and should notify their physician and immediately.
After the initial period of recovery a physical and occupational therapists will concentrate on an helping the individual to manage their daily life skills independently. A prosthetic will not be able to be fitted until the incision area has been heal. Until that time the individual will learn to use a wheelchair and will perform various exercises to strengthen the upper body and maintain the flexibility and movement in the amputated leg./p>
If an individual is strong enough following surgery they may be able to use a temporary artificial legs. This is a prosthetic that has an inflatable section around the newly formed stomped and is very successful in early rehabilitation. The permanent prosthetic cannot be measured until the swelling in the leg has decreased and the incision has heal.
RESOURCES
Orthotics and Prosthetics: A Manual for Below the Knee Amputation
Washington Musculskeletal Tumor Center: Below the Knee Amputation
MedlinePlus: Leg or Foot Amputation
University of Wisconsin: Below the Knee Amputation and Above the Knee Amputation