Amputation

What is amputation?

Amputation is surgery to remove all or part of a body appendage, usually a limb or extremity (an arm, leg, hand or foot). You might need surgery to amputate a body part if it’s too sick or injured to save and it endangers other parts. You might also need surgery if you lose a body part in a traumatic accident. When limb loss is unavoidable, amputation surgeons ensure that it’s clean and safe for the rest of you.

Common types include:

• Arm amputation.
• Hand amputation.
• Finger amputation.
• Leg amputation.
• Foot amputation.
• Toe amputation.

Less commonly, amputation can also mean removing a part of your face, like an ear, nose or tongue. A mastectomy is amputation of a breast. You can also have your testicles or penis removed (amputated).

Why is amputation done?

Devastating injuries and diseases are the usual causes of surgical amputation. In many cases, the body part has lost its ability to function as it should. Nerves no longer return sensation from the part or allow you to move it at will. Or blood vessels no longer nourish the tissues. Loss of sensation can cause injuries that you don’t notice, leading to infections. Loss of blood flow will eventually cause the tissues to die.

The surgery is usually a preventive measure. It helps preserve the health of the rest of your body. Tissue death, infections and cancer can easily spread from the sick part to the rest. A part that’s wounded beyond repair becomes a hazard if you can’t control it or protect it well enough. Removing the part also gives you the option to replace it with a more functional and aesthetic-looking prosthetic part.

What are the most common causes of amputation?

Common conditions that may lead to surgical amputation include:

• Complications of peripheral artery disease (PAD), which causes a loss of blood flow.
• Complications of diabetes, which causes nerve damage and loss of sensation.
• Nonhealing and/or infected foot and toe ulcers (often related to diabetes or PAD).
• Gangrene, tissue death from loss of blood flow, which can spread.
• Stage three frostbite that leads to irreversible tissue death.
• Life-threatening infections in your bones, joints or other tissues.
• Cancerous tumors that surgeons are unable to safely remove from your body part.
• Severe injuries, including severing, crushing and burn injuries.

What happens before amputation surgery?

If it’s not an emergency, you’ll go through a few steps of preparation before surgery:

Assessment

Your healthcare team will carefully assess the extent of your disease or injury. In some cases, they might be able to attempt to save your limb using advanced surgical techniques. This is called limb salvage surgery. If this is an option for you, your provider will discuss the risks and benefits with you. If not, they’ll use your assessment to plan your surgery.

Counseling

Amputation is more than the surgery itself. It’s a psychological and physical journey that will have lifelong repercussions. Likewise, your healthcare team will include more than surgeons. You may meet with a variety of therapists to prepare you for surgery and plan for your recovery. If you’re interested in a prosthetic limb, you’ll meet with a prosthetist to discuss your options.

What happens during the procedure?

During surgery, your surgeon will remove all diseased and damaged tissues. They’ll work to preserve as much healthy tissue as possible. They may need to repair individual nerves or blood vessels through microsurgery. They may also need to file or smooth the end of your bone, and they’ll often stitch your muscle to your bone to reinforce it. They’ll leave enough soft tissue at the end of the stump to close it.

You may have discussed plans for a certain type of prosthesis with your surgeon. In some cases, they might perform extra steps in your surgery to prepare you for that prosthesis. Examples include:

Target muscle reinnervation

This option for upper limb amputees can make it easier to control a myoelectric arm or hand. After amputating, your surgeon redirects the severed nerves that controlled your amputated limb to a new “target muscle” somewhere else on your body — often in your shoulder or chest. This allows you to operate your prosthesis more intuitively by activating this other muscle.

Osseointegration

Osseointegration means integrating your prosthesis with your bone (osseo-). Your surgeon implants a metal anchor into your bone that extends from the end of your limb. Your prosthesis can attach directly to it. This makes the prosthesis easier to attach and remove. It also helps to prevent some of the skin complications that a traditional prosthesis socket can sometimes cause.

Rotationplasty

Rotationplasty is rare a procedure that involves amputating part or all of your upper leg and reattaching your healthy lower leg as your upper leg. Your surgeon rotates your lower leg so that your ankle bends the right way to replace your knee. This allows you to use a below-the-knee prosthesis with your shortened leg, instead of needing an above-the-knee prosthesis.

What happens after surgery?

You’ll spend a few days to weeks recovering in the hospital after surgery. You’ll have oxygen through a mask, fluids through an IV and pain control as needed. You may have a urinary catheter and bedpan, so you don’t have to get up to go to the bathroom. Your healthcare team will carefully monitor your wound healing. Within a few days, a physical therapist will begin guiding you in small daily exercises to prevent stiffness.

You’ll continue your rehabilitation either at home or in a rehabilitation facility for people with limb loss. During this time, you’ll work with a variety of specialists to learn how to live with your changed body.

Your rehabilitation will likely include:

• Physical therapy. You’ll need to move regularly to prevent your tissues from stiffening. You’ll also need to learn to use your body in new ways, relying on different muscles than you used to.
• Occupational therapy. An occupational therapist helps you learn to adapt your practical life to your new body. They’ll teach you new ways to accomplish routine tasks at home and at work.
• Psychotherapy. Amputation is a profound psychological event. It will take time to adjust and to process through the full range of feelings it can evoke. It’s a good idea to have a mental health professional to talk to during this time. Your mental health is important to your overall recovery.
• Prosthesis fitting and training. If you plan to use a prosthetic limb, you’ll begin the fitting process after you’ve recovered. You’ll then spend several months learning how to use it.

What are the advantages of amputation?

Surgical amputation is almost always a life-saving or life-preserving procedure. Occasionally, it’s a choice between removing a damaged and dysfunctional limb or salvaging it and living with it as-is. This might mean living with chronic pain, a constant safety hazard or a limb that you can’t use. Alternatively, removing and replacing it with a more functional prosthesis might improve your quality of life.

What are the possible risks of amputation surgery?

Any major surgery carries some risk of complications. These can occur during or after surgery. Those who need amputation surgery may be more at risk of complications than others. This is because they’re often already in poor health. Preexisting conditions like cardiovascular disease, trauma, cancer and infections can contribute to the risk of sudden respiratory failure, heart failure or kidney failure.

Preexisting conditions can also make it difficult for your body to recover well. With reduced resources for healing, wounds may be slow to close or may reopen, and you may have excessive swelling or bleeding. Your stressed immune system may be too weak to fight infections like pneumonia, which can happen with extended bed rest. Bed rest and cardiovascular disease also make blood clots more likely.

How long does it take to recover from surgery?

Recovery times can vary. In general, it takes two to three months for your surgical wounds to heal and your swelling to go down. Once your residual limb has settled into its final size and shape, you can begin fitting for a prosthesis. You’ll begin physical therapy as soon as possible after surgery. You’ll likely continue with it for at least six months. Training to use a prosthetic limb can take even longer.

How painful is amputation?

If you experience it consciously, limb amputation is one of the most painful assaults your body can endure. Fortunately, you won’t feel it during surgery, and you’ll have strong pain control after surgery. While you’ll probably experience some postoperative pain, your healthcare team will do their best to help you manage it. However, limb loss can lead to other, longer-lasting pain syndromes, including:

• Residual limb pain. Pain in your residual limb or “stump” can have a variety of causes. Nerve damage from surgery can cause recurring nerve pain. Using a prosthesis can irritate the skin on your stump in various ways. You should address these issues with your prosthetist.
• Phantom limb pain. Many amputees experience periodic sensations, such as pain, that seem to come from their amputated limb. This happens because the severed nerves continue to transmit signals to your brain. Address phantom limb pain with your provider.
• Psychological pain. Understandably, limb loss can cause significant psychological distress, especially when it’s unexpected. It can feel overwhelming and can raise your risk of clinical depression and PTSD. You’ll need professional support to process the psychological pain.

What does it feel like to lose a limb?

To lose a limb is to lose an essential part of yourself that you’ve taken for granted all your life. It disrupts the way your body works to accomplish the most basic tasks and challenges your mobility and independence. It also changes the way it feels to live in your body, how it looks and your own self-image. This can be devastating to your confidence in yourself and in your ability to live a satisfying life.

It’s natural to grieve for this loss, and to struggle with shock, anger, fear or despair. You may feel daunted by the challenges ahead and the long, hard rehabilitation process. Your healthcare providers and fellow amputees know this territory well. They won’t expect you to resolve these feelings right away. Instead, your feelings will be your companions as you begin to move forward, one step at a time.

When should I contact my healthcare team?

During your recovery, reach out to your healthcare team whenever you have concerns or complications. Your team is there to counsel you and help troubleshoot issues as they arise. Contact your:

• Surgeon if your wound doesn’t seem to be healing or seems to be getting worse, or if you develop new symptoms, like a fever.
• Physical therapist if you have stiffness or challenges with movement, or if you have musculoskeletal pain from using one side of your body more than the other.
• Mental health professional if you need mental and emotional support in the form of therapy or medications.
• Prosthetist if your new prosthetic limb irritates your stump or doesn’t fit correctly.