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Amputation

Last updated May 26, 2018

Approved by: Krish Tangella MD, MBA, FCAP

Amputation is the surgical removal of a body limb, extremity, or appendage (such as toes and fingers); when affected by gangrene, disease, malignancy, arterial embolisms, arterial thrombosis, or injury.


Background Information:

What are the other Names for the Procedure?

  • Surgical Removal of all or part of a Limb

What is Amputation surgical procedure?

Amputation is the surgical removal of a body limb, extremity, or appendage (such as toes and fingers); when affected by gangrene, disease, malignancy, arterial embolisms, arterial thrombosis, or injury.

What part of the Body does the Procedure involve?

Amputations are performed on the arms, legs, hands, feet, fingers and toes. 

Why is the Amputation surgical procedure Performed?

The procedure is performed as a surgical option to control disease, gangrene formation, malignancy, and excessive pain. In some cases, Amputation may be performed as a preventative measure when the patient is suffering from any of the above mentioned ailment. Apart from these, some other indications for an Amputation are:

  • Buerger’s Disease
  • Raynaud’s Phenomena
  • Frostbite
  • Hardening of the arteries
  • Irreversible damage to an artery, causing loss of blood supply to the body parts

What are some Alternative Choices for the Procedure?

Alternatives to Amputation depend primarily on two main factors and they are: the medical cause and the degree of medical urgency. In some cases, drug therapy may be considered as an alternative.

What are the Recent Advances in the Procedure?

When the affected limb or appendage has become completely diseased or damaged, Amputation remains the only option to prevent further damage to other adjoining parts of the body. Amputation is an old age procedure and no significant advances have been as yet made, to replace this procedure. 

What is the Cost of performing the Amputation surgical procedure?

The cost of Amputation procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

  • It is normal for a patient to feel uncomfortable and confused by the information regarding Amputation and on what needs to be done
  • If the patient needs further reassurance or a second opinion, a physician will almost always assist and also recommend another physician, if required

What are some Helpful Resources?

http://www.surgeryencyclopedia.com/A-Ce/Amputation.html#b 

Prior to Amputation surgical procedure:

How is the Amputation surgical procedure Performed?

  • Amputation is performed under general anesthesia or regional anesthesia
  • During this procedure a ligature is applied on the patient. This helps by stopping blood supply to the affected area and hence preventing hemorrhage
  • Next an incision is made just above the affected area or the area that needs to be amputated. The tissues, muscles, nerves, and blood vessels are cut and the bone is severed with an oscillating surgical saw
  • The sharp edges of the bone are filed (blunted) and then covered with the neighboring tissue
  • The muscles and then the skin are closed with sutures respectively and the area bandaged
  • In rare cases, a prosthetic device is surgically inserted almost immediately at the stump

Where is the Procedure Performed?

An Amputation is performed at an out-patient surgery center facility, or a hospital that is equipped to conduct such a surgical procedure.

Who Performs the Procedure?

A general surgeon, a vascular surgeon, or an orthopedic surgeon performs an Amputation procedure.

How long will the Procedure take?

The time taken to perform an Amputation depends on the part of the body being amputated. It may take anywhere between an hour to 4 hours, to complete the surgery. 

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the surgical procedure and helps avoid unnecessary complications.

  • Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
  • If you are allergic to any specific medication or food items
  • If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
  • If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
  • If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
  • If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
  • If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
  • A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

  • Before the procedure is performed, extensive medical testing is done to determine the proper level of Amputation
  • These tests are designed to measure blood flow through the limb. Several different types of testing can be done to help choose the proper level of Amputation
  • The surgeon’s goal is to find the sight of Amputation, where healing is most likely to be complete, even while allowing a maximum amount of limb to remain, for effective rehabilitation
  • The greater the blood flow through an area, the better it is; as there is more likelihood that healing will occur post-surgery

A physician will request your consent for the Amputation procedure using an Informed Consent Form.

What is the Consent Process before the Procedure?

A physician will request your consent for the Amputation procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Amputation surgical procedure?

Prior to the surgery, the patient must get a routine blood and urine test done. Additionally, the surgeon may also suggest an X-ray of the affected area and an arterial doppler. 

During the Amputation surgical procedure:

What kind of Anesthesia is given, during the Procedure?

A general anesthesia is administered during the surgical procedure.

How much Blood will you lose, during the Procedure?

  • The amount of blood loss depends on the part of the body being amputated
  • In case of Amputation of a smaller part of the body like a toe or a finger, the amount of blood lost is a lot lesser, than when an entire limb is removed

What are the possible Risks and Complications during the Amputation surgical procedure?

The possible complications that may arise during such a type of surgery are:

  • Excessive bleeding or hemorrhage
  • Blood clot formations
  • Infection

What Post-Operative Care is needed at the Healthcare Facility after the Amputation surgical procedure?

The healthcare facility must have an intensive care unit (ICU) attached, for immediate post-operative care and recovery, if needed. This is especially important when a larger limb is involved in the surgical procedure.

After the Amputation surgical procedure:

What are the possible Risks and Complications after the Amputation surgical procedure?

There could be a possible risk or complication in the post-surgery period. This includes:

  • Infection
  • Failure of the stump to heal
  • Persistent pain in the stump
  • Condition of phantom limb
  • Arterial or pulmonary embolism
  • Muscular contractions

What is the Prognosis after the Surgery?

Post-surgery, almost all the patients experience some amount of psychological trauma and emotional discomfort for certain duration of time. About 50-80% of the patients have phantom limb experience.

When do you need to call your Physician?

The patient must inform the physician if pain, swelling, redness or bleeding increases in the area around the stump. Similarly, if any signs of infection are noticed, or the patient develops weakness, fever and dizziness; then a consultation with the surgeon may be necessary.

What Post-Operative Care is needed at Home after the Amputation surgical procedure?

At home, the following post-operative care is recommended, after Amputation procedure:

  • Ensure that the patient completes the course of prescribed medication
  • Keep the area around the stump clean and dry
  • Adhere to the physical therapy and rehabilitation program regimen
  • Take part in, and complete the psychological counseling sessions
  • Avoid smoking
  • Ensure that the blood sugar count is kept under control
  • Take complete bed rest, per physician’s advise

How long does it normally take to fully recover, from the Procedure?

It takes about 6 weeks to fully recover from the surgery.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The tissue is taken for further examination and later disposed, as per the standard medical procedure.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

  • The tissue removed is processed in the laboratory under a pathologist's supervision
  • Slide(s) are prepared once the tissue is processed and this is examined by a pathologist and a pathology report issued
  • Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time

Who will you receive a Bill from, after the Amputation surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers. 

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

  • The outpatient facility or a hospital
  • The orthopedic surgeon or a general surgeon, or vascular surgeon
  • An anesthesiologist (if anesthesia was administered)
  • A pathologist (if the tissue was sent for analysis) 

The patient is advised to inquire and confirm the type of billing, before an Amputation is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA

Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: May 21, 2013
Last updated: May 26, 2018