The decision to have a limb amputated is difficult for the person and
his or her doctor. Many times, extensive measures have been tried to save the
limb. The major causes of amputation are
peripheral arterial disease that results in either
painful, poor limb function or
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In doing the amputation, the surgeon seeks to remove all dead or
dying tissue. Goals of amputation are to relieve pain, encourage wound healing,
and increase a person's ability to carry out his or her daily activities.
Amputations and bypass grafting surgery may be planned at the same
time to achieve the best results. For example, a person who has gangrene may
have an amputation of part of the foot or leg while also having bypass
grafting in an attempt to preserve still-living tissue. In a person who is not
a candidate for revascularization or who has not had success with previous
bypass grafting attempts, amputation alone may be recommended for severe pain
at rest, nonhealing ulcers, and/or gangrene.
People with major medical problems, such as diabetes or heart, lung,
or kidney problems must be carefully assessed and their medical care optimized
before the operation. The importance of the preoperative evaluation cannot be
overemphasized. People who have amputations are often chronically or seriously
ill. And their risk of dying around the time of the operation as well as in the
following years is higher than for other people of the same age.
At which level should the amputation be done?
The appropriate amputation level depends on a number of factors,
including why the amputation is needed, the general health of the person, the
possibility for recovery and rehabilitation (rehab), and the probability of adequate
wound healing. The aim of an amputation is to remove all dead and dying tissue
while creating the most useful limb for recovery and rehab. It is very
important to make sure that an artificial limb, if desired, can be appropriately fitted.
A below-the-knee amputation is usually preferable. It provides
better mobility. Even if a person is very unlikely to be able to walk because
of their general health or other medical conditions, a below-the-knee
amputation provides for easier transfers and movement while in bed. Walking on
an above-the-knee prosthesis (artificial limb) requires a lot more
energy than walking on a below-the-knee prosthesis, although young, relatively
healthy people manage much better than older, more frail people do. But when a
below-the-knee amputation cannot be done, an above-the-knee amputation has
the advantage of easier healing.