Amputation Procedures

Leg Amputation Procedures
 

When to Remove a Leg
  • There are many reasons that a doctor may decide to amputate your leg. In some cases, the limb is removed due to severe trauma suffered in a car accident or some other sort of accident. Poor blood flow to the leg can also be a reason to amputate. Poor blood flow does not allow the leg the nutrients it needs to survive. Infections also cause many people to lose their legs. Some infections that enter the blood stream cannot be controlled or stopped; the last resort for stopping an infection in the leg from traveling to the heart is to remove the leg. Cancerous and non-cancerous tumors are yet another reason why doctors choose to amputate. Wounds that do not heal and that increase the chance of infection to the limb which may spread to the rest of the body are also cause for amputation. Finally, severe exposures to heat or cold, such as burns or frostbite, are determinants for amputation, since infection can spread to other areas of the body easily when these conditions occur. Severe exposure often kills the area of the body exposed and those exposed areas must then be removed to prevent further injury.

Procedures

  • There are three major procedures commonly used for removing the leg from the body when necessary. One procedure calls for amputating above the knee, while another procedure calls for amputation below the knee. The third type of leg amputation can be done at the hip. The essential goal of the amputation is to ensure that the stump that remains is as small as possible in order to fit a prosthesis. The type of amputation that one is given often depends on the extent of the injury. Often doctors like to try and keep the joints in place. Therefore, a below the knee amputation is preferred whenever possible.

Following Amputation

  • Many amputees live relatively normal lives once they adjust to the idea of losing their limb and participate in physical therapy. Physical therapy after losing a limb is essential to learning how to walk again and in reducing the size of the stump immediately after surgery. Several weeks after surgery, once the swelling of the stump has gone down, prosthesis can be fitted to help an amputee walk again. Although it will take months of intense physical therapy, and following doctor's orders concerning stump care and muscle building, it is physically possible to regain almost 100 percent motility
     

During the Procedure of an Amputation:

An amputation requires a stay in a hospital. Procedures may vary depending on the type of amputation, your condition, and your physician's practices. An amputation may be performed while you are asleep under general anesthesia, or while you are awake under spinal anesthesia. If spinal anesthesia is used, you will have no feeling from your waist down. Your physician will discuss this with you in advance.

Generally, an amputation follows this process:

  1. You will be asked to remove any jewelry or other objects that may interfere with the procedure.

  2. You will be asked to remove your clothing and will be given a gown to wear.

  3. An intravenous (IV) line may be started in your arm or hand.

  4. You will be positioned on the operating table.

  5. The anesthesiologist will continuously monitor your heart rate, blood pressure, breathing, and blood oxygen level during the procedure.

  6. A urinary catheter (thin, narrow tube) may be inserted into your bladder to drain urine.

  7. The skin over the surgical site will be cleansed with an antiseptic solution.

  8. To determine how much tissue to remove, the physician will check for a pulse at a joint close to the site. Skin temperatures, color, and the presence of pain in the diseased limb will be compared with those in a healthy limb.

  9. After the initial incision, it may be decided that more of the limb needs to be removed. The physician will maintain as much of the functional stump length as possible. The physician will also leave as much healthy skin as possible to cover the stump area.

  10. If the amputation is due to trauma, the crushed bone will be removed and smoothed out to help with the use of an artificial limb. If necessary, temporary drains that will drain blood and other fluids may be inserted.

  11. After completely removing the dead tissue, the physician may decide to close the flaps (closed amputation) or to leave the site open (open flap amputation). In a closed amputation, the wound will be sutured shut immediately. This is usually done if there is minimal risk of infection. In an open flap amputation, the skin will remain drawn back from the amputation site for several days so any infected tissue can be cleaned off. At a later time, once the stump tissue is clean and free of infection, the skin flaps will be sutured together to close the wound.

  12. A sterile bandage/dressing will be applied. The type of dressing used will vary according to the surgical technique performed.

  13. The physician may place a stocking over the amputation site to hold drainage tubes and wound dressings, or the limb may be placed in traction or a splint, depending upon your particular situation.
     

Step by Step the performing of an above the knee amputation

Amputation of a leg:

Why this operation?

Amputation of one of the limbs is used as the last remedy for the treatment of a disease or illness if there is no more safe alternative .A limb, which became useless, threatens often the wellbeing of the rest of the corpse.

Causes can be:

decay of tissue (gangrene)

hardening of the arteries

long exposure to cold (freezing)

diabetes

serious infection

cancer, especially bone cancer

deformation or dysfunction

irreparable tissue damage (like shattering)

-...

Whatís the objective of the operation?

The objective of the surgeon is to remove all the ill tissue and to form and prepare the stump for attachment of a prosthesis. Itís rarely necessary to remove the whole limb and the stump will help to bend the joint, which contributes to the balance and movement. The longer the stump, the longer the leverage that remains implicating better muscle control en the easier an artificial limb can be used.

What happens exactly during the amputation?

If there is an infection, there Ďll be first an intensive cure with selected antibiotics. Local infection of the skin on the spot were the amputation was planed, can delay the operation, unless the delay itself is dangerous.

Preliminary steps:

The evening before the operation, the whole leg is shaven from the groin to just below the knee. Next, the skin is scrubbed with antiseptic soap. Amputation of the thigh is usually performed with the use of anesthetics. Many surgeons prefer full narcosis. In that case, youíll get an injection an hour before the operation.

The operation, step-by-step:

When youíre anaesthetized, youíll be put on your back, with the limb that will be amputated close to the edge of the table. The surgeon can use a turnstile just above the place of amputation ; it diminishes bleedings considerably, but it makes the main arteries less noticeable.

When an amputation is made as an emergency, the surgeon can make a simple incision around the leg and perform a guillotine-amputation. In that case, a second operation is necessary to create a useable stump.

The leg that will be amputated is drawn aside and cleaned again with antiseptic fluids and wrapped in sterile cloths. The surgeon makes two special slices of skin and underlying soft tissue. The slice at the front is bigger than the slice at the back, to the stitches arenít located at the sawn end of the bone.

Skin and soft tissue contract usually a lot, so that the incisions that are made by the surgeon, must be at least 15 centimeters below the point where the bone is sawn.

The surgeon must be very careful in order to prevent damaging the main artery and vain, the blood-vessels of the thigh. When they arenít covered, theyíll be pinched off and stitched with catgut and cut. There will be formed, to repair the blood circulation to the limb, new connections between arteries and veins.

The surgeon now identifies the main nerve of the leg (nervos ischiadicus). This is pulled down as far is possible, and fixated with catches, tied up and pinched off, followed by shrinking to pull it back, higher in the leg.

This retraction is very important for the nerve because, if it remains at the end of the stump, there will be the forming of neuroses, which could make the fitting of a prosthesis very uncomfortable. The thighbone is now uncovered and the membrane is stripped off. The surgeon saws the bone and rounds off the bone with a rasp of steel.

Eventually the surgeon stitches the skin slices together en a woolen bandage is placed around the stump. Some surgeons place a cast around the stump. Inside the cast, there's a pylon to connect an artificial limb. The pylon is temporarily and meant to enable you to walk as quickly as possible.

 What can you expect immediately after the operation?

The narcosis can give you some headache. Pain, concentrated around the stump isnít that bad and can be cured with painkillers. If the stump is made with a pylon, you can start walking with crutches as soon as possible. Exercises like this speed up the healing, diminish the pain and prevent muscles from degenerating. First, there will be a cotton, elastic bandage to stimulate the shrinking of the stump. This bandage is replaced every 4 hours to stimulate the stump to shrink

What are the long-term effects?

It can take 6 weeks to stabilize the stump. A permanent prosthesis can only be attached if the healing is completed. Youíll have probably phantom pains. You imagine that your leg is still there. This will disappear after sometime. Youíll get a balanced program of training and revalidation. The long-term perspectives of the mobility of a person is strongly depended from the age, the mental state and the physical condition of the patient and the fact that the prosthesis causes pain or not.