Below-the-Knee Amputation Overview

This is the surgical removal of the leg below the knee.

Prior to Procedure

If your surgery is planned, your doctor will review the surgery and what to expect. He will talk to you about how you are going to move after surgery. You may need a prosthesis (artificial limb), walker , crutches , wheelchair , or a combination of these.

At your appointment before your surgery, your doctor may:

• Examine your leg (check pulses, skin temperature, skin appearance, and sensitivity to touch)
• Ask you questions like:

• What kind of help do you have at home?
• Would you like to talk to a therapist about the amputation?

You should ask your doctor questions like:

• What kind of rehabilitation will I need?
• How long will my recovery be?

Before surgery, you may:

• See a physical therapist who will explain rehabilitation after surgery.
• Be asked not to eat or drink for 8-12 hours before your surgery—Ask your doctor if you should take regular medicines with a sip of water before surgery.
• Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the surgery. Medicines stopped may include:

• Anti-inflammatory drugs (eg, aspirin )
• Blood thinners like clopidogrel (Plavix) or warfarin (Coumadin)

Anesthesia

General anesthesia or regional anesthesia will be used. General anesthesia will block pain and keep you asleep during surgery. It is given through an IV (needle) in your hand or arm. Regional anesthesia will numb your leg and the surrounding area. You may also receive IV sedation.

Description of Procedure

Once you are asleep and no longer feeling pain, a breathing tube will be placed if you have general anesthesia. The doctor will make a cut in the skin below the knee. The muscles will be separated and blood vessels clamped. A special saw will be used to cut through the bone. The muscles will be sewn and shaped so that a stump is formed to cushion the bone. Nerves will be separated and placed so that they do not cause pain. Blood vessels will be tied off. The skin will be closed over the muscles, forming the stump. Drains may be inserted into the stump to drain blood for the first few days. A dressing and compression stocking will be placed over the stump.

Below-the-Knee Amputation © 2009 Nucleus Medical Media, Inc.

Immediately After Procedure

You will be taken to the recovery room for observation. If all is well, your breathing tube will be removed. You will be transferred to your hospital room for recovery.

How Long Will It Take?

Several hours (depending on your health and the reason for the surgery)

How Much Will It Hurt?

During surgery, you will not feel pain. After surgery, you will be given pain medicine. You may feel phantom pain . If you do, tell your doctor.

Average Hospital Stay

5-14 days (Your doctor may choose to keep you longer if complications occur.)

Post-procedure Care

At the Hospital

• You will receive antibiotics to prevent infection.

• You may be taught how to change your dressing.

• Physical therapy will begin in the hospital. Your therapist will show you how to stretch your hip and leg muscles to maintain range of motion. You will learn how to get in and out of bed and how to put weight on your leg. You may be taught how to use crutches, a walker, or a wheelchair until you can be fitted with a prosthesis.

While in the hospital, you may be asked to move your stump often. This will allow circulation and prevent contractures (stiffening causing loss of joint movement).

At Home

When you return home, do the following to help ensure a smooth recovery:

• Get help from family and friends.
• Change your bandages, replacing them with sterile bandages.
• You will need to continue physical therapy to build strength, maintain range of motion, and learn how use a prosthesis.
• Take care of your stump and prosthesis.
• Many people feel depressed after this type of surgery. Consider talking to a therapist or psychologist.
• Check with your doctor about which medicines to take at home.
• Be sure to follow your doctor's instructions .

RESOURCES:

American Diabetes Association
http://www.diabetes.org/home.jsp

American Orthopaedic Foot and Ankle Society
http://www.aofas.org

Amputee Coalition of America
http://www.amputee-coalition.org/Index.html

CANADIAN RESOURCES:

Canadian Diabetes Association
http://www.diabetes.ca/

Health Canada
http://www.hc-sc.gc.ca/index_e.html

References:

Amputation. Society for Vascular Surgery website. Available at: http://www.vascularweb.org/patients/NorthPoint/Amputation.html . Accessed September 14, 2009.

Badash M. Amputation, above-the-knee. EBSCO Health Library. Available at: http://www.ebscohost.com/thisTopic.php?marketID=15&topicID=81 . Last reviewed November 2008. Last updated July 21, 2009. Accessed September 14, 2009.

Leg amputation. Merck Manual website. Available at: http://www.merck.com/mkgr/mmg/sec3/ch29/ch29e.jsp . Accessed September 14, 2009.

Leg amputation rehabilitation. Merck Manual website. Available at: http://www.merck.com/mmpe/sec22/ch336/ch336i.html . Accessed September 14, 2009.

Professional Guide to Diseases. 9th ed. Ambler, PA: Lippincott Williams & Wilkins; 2009.