The main sites of amputation
Amputation is always a last resort and will only be recommended if your surgeon has decided it is not possible to improve the circulation in any other way.
Just below the knee
Through the knee
Through the thigh
The site of amputation will depend on how poor the blood supply to your leg is. If possible, below knee amputations are performed, as it is easier to walk with an artificial limb after the operation. However, many people do well after a thigh amputation.
The following information will help to explain the procedure of leg amputation:
Before your operation:
You will usually be admitted for one or two days before your operation. You will be admitted to your bed by one of the nurses. Who will also note down your personal details in your nursing records.
There are a number of tests that need to be done to make sure that you are fit for the operation. These will include:
X-ray of the arteries (arteriogram) to confirm where the blockages are located.
ECG (a heart tracing).
You will be visited by the Surgeon who will be performing your operation and also the doctor who will give you the anaesthetic. They will decide where on the leg the amputation will happen. If you have any questions regarding the operation, please ask the doctors.
In the anaesthetic room, you will be given a general anaesthetic to put you to sleep. Alternatively, you can have a tube inserted into your back, through which painkillers can be given to numb the lower half of your body whilst you remain awake (spinal or epidural). The anaesthetist may also use an epidural as well as a general anaesthetic to provide pain relief after your surgery.
Whilst you are asleep, tubes will be inserted into your bladder to drain your urine, and into a vein in your arm or neck (or both) for blood pressure measurements and to give you fluids following surgery.
The amputation stump will often be closed with a stitch under the skin that dissolves by itself, and occasionally a small tube to drain any fluid that builds up afterwards. A clear plastic dressing may be used to allow the stump to be inspected, but bandages or a plaster cast are sometimes used.
After the operation:
You will usually return to the ward once you have recovered from the anaesthetic. Sometimes the anaesthetist may decide to send you to the Post-Operative Surgical Unit (POSU) or High Dependency Unit (HDU) in order to be able to monitor your progress more closely.
You will be given fluids by a drip in one of your veins until you are well enough to sit up and take fluids and food by mouth. The nurses and doctors will try and keep you free of pain by giving painkillers by injection, via a tube in your back, or by a machine that you are able to control yourself by pressing a button.
It is quite common to experience pain that feels as though it is in part of the leg that has been removed (phantom limb pain) and this can be helped with medication and rapidly disappears. You may also require a small blood transfusion.
As you recover, the various tubes will be removed, and you will become gradually more mobile until you are fit enough to go home.
You will be visited by the physiotherapist before and after your operation, who will help you with your breathing (to prevent you developing a chest infection) and with your mobility. Initially you will be shown exercises in bed, and then you will be encouraged to transfer from your bed to a chair.
As your wound heals, the physiotherapist will start you walking with help, on a temporary artificial limb, if it is felt safe for you to wear one. If not, you will be taught how to use a wheelchair.
You will also be visited by an occupational therapist who will help with your rehabilitation. Even if you are planning to walk, you may still need a wheelchair temporarily or for long trips.