At which level should the amputation be done? continued...
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.
Sometimes a bypass grafting operation may be done to allow a
below-knee amputation site to heal adequately. The most important thing in
deciding whether a below-knee amputation will heal is the clinical judgment of
a knowledgeable surgeon.
When is the right time to operate?
In general, amputations for sudden ischemia (when a clot develops and
completely blocks blood supply to an extremity) are done to control pain
soon after the preoperative evaluation is finished, if possible.
Bypass surgery or angioplasty is always done when possible.
Amputation is the last option.
Noninfected gangrene of the fingers and toes can be treated by
amputation or can be allowed to "autoamputate" (tissue dies and sloughs off on
its own) over a period of time, usually months. Gangrene of other extremities
Infected gangrene should be treated with the goal of getting rid of
the infection yet preserving as much of the extremity as possible. Dead or
dying infected tissue should be removed (debridement) as quickly as possible.
Tissue that is infected but may likely heal should be left. And the person
should receive intravenous antibiotics.
If a person is not stable or does not respond to antibiotic treatment
and debridement, amputation must be done rapidly. A first emergency
amputation is often done with the goal of stabilizing the person. And a
second elective operation may be done to remove any further dead tissue and to improve the function of the remaining