The prospect of undergoing a lower limb amputation can be frightening. If your doctor has told you that one is necessary, you might be wondering what will happen after the surgery. How long will it take to heal? How should you care for the wound? What about getting a prosthesis?
Knowing what to expect can help you plan ahead. Here’s what you need to know to promote healing so you can get back to your regular lifestyle.
Preparing for surgery in an ideal situation, you would know ahead of time that you need an amputation and you’d have some time to prepare mentally and physically. The better shape you are in before the amputation, and the better your physical rehabilitation is after the surgery, the more quickly your wound will heal and the sooner you’ll be able to walk again. Therefore, if you know you’re going to have an amputation, it’s important to build up strength in your upper and lower body. Your primary care doctor or surgeon can recommend a physical therapist to help you. Then you can schedule the surgery for when your body is in optimal condition.
Unfortunately, it’s not always possible to plan an amputation. For example, a chronic infection may suddenly get worse, leading to emergency surgery. If that’s the case, amputation may provide some relief and hope for a new beginning. The infection will be gone, which should lead to an overall improvement in your health and well-being.
There are several kinds of amputation. Amputation may involve the removal of one or more toes, the forefoot, the entire foot, or much of the leg. Several factors determine the type of amputation you’ll have. First, it depends on how well the blood circulates in your lower leg(s). There must be enough blood flow to the amputation site for healing to occur. Your doctor can determine how much circulation there is by physical examination or ultrasound. Second, the surgical site must be clear of infection yet have an adequate limb length to fit a prosthesis (an artificial limb).
If an amputation involves only the toes or forefoot, the wound will granulate, or form small bumps of tissue, as it heals. Therefore, it will need clean dressings for protection until the wound is gone. Most people with this kind of amputation return to walking with no special equipment other than a custom shoe. You may be able to go home the same day of the procedure with no hospital stay.
An amputation will be performed below the knee if it’s not possible to save the foot because of infection or poor circulation. After the surgery, your knee will be placed in a temporary splint to keep it still. This will keep the incision from stretching out. Also, it’s best to keep the knee from moving because bending it for prolonged periods of time can affect the fit of a prosthesis.
If the circulation in the lower leg has been severely damaged, or there is an infection that could interfere with healing, the amputation will be done above the knee.
The incision will be closed with stitches or staples. If there is a stump, it will be wrapped with a stockinette or Ace wrap. It may be wrapped in elastic wrap every one to five hours to control swelling.
Amputations at or above the knee may require several days in the hospital or in a rehabilitative care facility. When you get home, you’ll have to keep the wound dry until the stitches or staples are removed, which is usually about two to three weeks after surgery. Sponge baths are recommended instead of regular baths or showers so that you don’t get the stitches or staples wet. It’s important to get up and about within the first day or so after the surgery. Then, for the next few weeks, you’ll receive physical rehabilitation. The therapist will help you regain your balance, teach you how to get from your bed to a chair and show you strengthening exercises and how to use crutches. Good blood sugar control will help you heal and help keep your remaining limb healthy.
In another week or two, you should be ready to be fitted for a prosthesis. This will be done by a prosthetist, a person specially trained to measure, make and fit a prosthesis.
The goal is to have it fit as close in appearance and function to the natural limb as possible. Prostheses have several different parts, including sockets, flexible inserts and suspension systems that distribute pressure on the stump evenly. They are designed so that you can wear shoes with heals ranging from 3/8 ” to 1 ¼” high.
Once the prosthesis becomes available, more intensive rehabilitation begins. You’ll learn to walk again.
Phantom Limb: After the amputation, you may have the sensation that the amputated limb is still there. You may feel tingling, numbness or pressure. This is called “phantom limb sensation.” Many people who have had amputations experience phantom limb sensation soon after the amputation.
When the phantom limb sensation you feel is painful, it’s called “phantom limb pain.” Common treatments for phantom limb pain include drugs such as ibuprofen, anticonvulsants, narcotics, antidepressants, electrical stimulation, psychological counseling, biofeedback and acupuncture. The pain may resolve itself within a year, or ongoing treatment may be required.
Doctors aren’t sure what causes phantom limb pain. It may occur because of nerve activity in the stump. It may also come from nerve activity in the spinal cord, or it may originate in certain parts of the brain as the brain “rewires” itself to adapt to the amputation.
Check your insurance carrier to see what costs will be covered. Amputations themselves are usually covered, but the exact amount of reimbursement differs among insurance providers.
For rehabilitation and prostheses, Medicare and some private insurance payments are based on what your doctor or prosthetist predicts about your future ability to walk or get around. The more potential you show, the more willing Medicare and other insurance providers will be to invest in your rehabilitation. Also check to see whether your provider will pay for durable medical equipment such as walkers, crutches, wheelchairs or shower/tub safety bars.
Financial help is not the only help available. There may come a time when you need someone to talk to. The road to independence can be difficult and take a lot of hard work. It can lead to exhaustion or depression; sometimes it’s difficult to tell the difference between the two. You might find it hard to cope with the changes in your body, or you might be afraid of how others will react to your amputation. If you are feeling overwhelmed, don’t be afraid to ask for help. Your doctor may be able to recommend a mental health professional. Many people with amputations have found support groups to be extremely helpful.
Recovering from an amputation may seem like a formidable task, but knowing what to expect ahead of time can help you regain your independence.
Carol Dunlap, RN, MSN, CRNP, is a nurse with the University of Pittsburgh Medical Center Vascular Surgery Department and Wound Healing and Limb Preservation Clinic in Pittsburgh, PA. She has more than 20 years of experience in would healing.
Additional Resources: The American Physical Therapy Association 1111 North Fairfax Street, Alexandria, VA 22314 (800) 999-APTA (2782) www.apta.org
The Amputee Coalition of America 900 East Hill Avenue, Ste 285, Knoxville, TN 37915 (888) AMP-KNOW (267-5669) www.amputee-coalition.org