Overview

Amputation is when a limb or part of a limb is removed.

You might have a leg amputation if you have had an accident, or you might have surgery to remove your leg if you have a serious problem in the leg that needs treating.

Having a life-changing procedure is bound to feel daunting. Our team is here to care for you, and support you with any worries or questions you might have.

Your medical team includes many skilled professionals who will look after you and support you in your recovery.

Reasons for an amputation

The main reasons someone might need an amputation include the following.

Not having enough blood flowing to the leg

When you walk, your muscles need more blood supply to work properly.

In some people, particularly people who smoke or have diabetes, blood vessels in the leg can become more narrow. This can happen over a few years. You might get pain in the thigh, calf or foot when you walk. The pain goes away when you rest. This is called intermittent claudication.

There might be a blockage in a large blood vessel that stops blood getting to the leg. If this happens, you might have a bypass operation so the blood can flow past the blockage. Smaller blood vessels can also become blocked.

If a bypass operation is not possible or does not work, an amputation might be needed.

An infection in your leg

People with poorly controlled diabetes are more likely to get infections. An ulcer or seriously infected toe that does not heal properly can spread infection into the tissues and bones of the leg. An amputation might be needed to remove the infection.

A serious accident

Sometimes, broken bones do not heal after an accident. Injury to blood vessels and nerves can also mean that the damaged part of the leg needs to be removed.

Removing a tumour in your leg

Amputation might be the only way to remove a tumour in the muscle, bone or skin. If you have had an amputation for this reason, you might have chemotherapy or radiotherapy. You might need to finish this treatment before you can start using an artificial limb (prosthesis).

Severe pain and not being able to walk on the leg

An amputation might be done if you are not able to use your leg, you find it very difficult to walk, or you cannot walk. This situation often causes severe pain. For some people, amputation will allow them to wear a prosthesis and be more mobile.

Severe ulceration of the leg

When a sore (ulceration) on the leg is so bad that healing is impossible, an amputation might be needed.

Levels of amputation

The amount of the leg that is amputated will depend on how good the blood supply is to the leg, how far the infection has spread, or where the tumour is. Your doctor will talk to you about the level of amputation that is best for you.

It is very important that the leg is amputated at a level where there is a good blood supply, no infection and no tumour. This gives the area the best chance of healing after the operation.

It is also important for the amputation to be at the right level so that if you use a prosthesis it will fit properly.

Amputation can be at any level, but the most common are:

• a single toe
• through part of the foot
• below the knee
• through the knee
• above the knee
• through the hip joint

Not everyone who loses part of their leg will be able to use a prosthesis. This depends on many different things. For example:

• your healing after the amputation
• your overall health
• the condition of your remaining limb
• how you were able to walk before the amputation

The physiotherapists will visit you on the ward to talk about your amputation and the rehabilitation process to help you gain your independence again. They will also discuss prosthetic use if it is appropriate.

Before surgery

The physiotherapist will try to meet with you before your surgery. They will explain what physiotherapy you will have. You will be encouraged to keep walking regularly until your surgery, if you are able to. You will be given walking aids and some exercises to do.

They might check your muscle strength and your joints. The fitter and stronger you are before your surgery, the easier you will find moving around after surgery.

Speak to your physiotherapist if you would like to meet other people who have had an amputation, and see the exercises and training they are doing. You can also talk to someone about how you are feeling, and your emotions, before your surgery. 

During surgery

The surgery will usually be done using a general anaesthetic, which is medicine that means you will be asleep the whole time.

Sometimes, a regional anaesthetic is used. This is an injection in your spine, which numbs a large part of your body (such as a leg). You will be awake, but you should not feel any pain.

If you are having a regional anaesthetic, you might also be given some sedation.

Your anaesthetist will decide the best type of anaesthetic for you, and talk to you about which one you are having. You can speak to them about any concerns you have. 

After surgery

You willl probably feel some discomfort after surgery, but you will be given pain medicine to help. Tell your nurse if you are uncomfortable.

The remaining part of your leg (called the residuum, or stump) will have stitches. Sometimes these stitches are dissolvable and do not have to be removed. Your nurse will explain what kind of stitches you have.

You might have a drain, which will take away any blood and fluid from your wound. This is usually removed about 1 day after surgery.

Your leg will be covered with a bandage or a rigid dressing, which is like a plaster cast.

The rigid dressing is used for below the knee amputations. It helps you keep your leg protected from trauma if you knock it or fall. It also helps control the swelling and helps keep the knee straight. The dressing can stay on while you are in hospital but the nurse needs to check underneath it each day.

Most patients also have a small drip directly into the stump which is called a peripheral nerve catheter. This is a pain medicine which is directed straight into the leg to numb the nerves. This is removed by day 5 after your operation.

You might have a small tube in a vein in your arm. The nurses will give you fluids through this tube until you are able to eat and drink as usual.

You might have a catheter going into your bladder. This is used to monitor the amount of pee (urine) you are producing after surgery, and to make sure your kidneys are working well.

Phantom pain and sensation

After surgery, people can sometimes feel that their leg is still there. This is known as phantom sensation. You might also feel pain in the leg that has been removed. This is called phantom pain.

We do not know what causes phantom pain. Scientists believe that both phantom pain and phantom sensations come from the spinal cord and the brain.

Phantom pain can be severe, but pain medicine can help. Tell your doctor, nurse or physiotherapist if you have any pain. The pain can be treated.

It is important that you tell your nurses if you have phantom pain, or pain in the part of your leg that is left, as you will need different painkillers for the different types of pain.

Risk of falling

If you feel your leg is still there, you are at a very high risk of falling. A lot of people fall shortly after an amputation, as they think their leg is still there and try to walk.

A fall could damage the stump. Any damage to the stump might need surgery to repair it.

It is very important that you do not hop anywhere, even if it is a short distance.

Hopping is dangerous and can easily lead to a fall because your balance will be different after your surgery. It also puts an added strain on your other leg.

Take your time and think carefully before you move, especially when moving on and off a bed or chair. Being careful can help to prevent falls.