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Amputees Amputees
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Fever |
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Cool skin near your wound |
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Extremely painful skin |
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Wound odor |
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Infected or non-healing sores or wounds |
Your physician will also arrange for tests to see how well blood is reaching your limbs. These tests may include blood pressure tests, duplex ultrasound, and angiography,
If you have any other conditions, such as diabetes, high blood pressure, heart problems, poor kidney function, or infections, your physician will discuss with you how to treat them to get you in the best condition. Your physician will also test your physical strength, balance, and coordination to assess your potential for rehabilitation. If you are going to use an artificial limb, sometimes your physician may arrange for you to be measured for the device before your operation. This way, your artificial limb will be ready as soon as you recover. Often, however, your physician may advise waiting until your incision is healed adequately before getting your artificial limb. You also may receive counseling before your surgery to help you adapt to the loss of your natural limb.
Your physician will discuss with you whether to reduce or stop any medications that might increase your risk bleeding or other complications. If you have any allergies to anesthesia, pain medications, or antibiotics, you should tell your physician at this time.
When do I need amputation?
Most people who require an amputation have PAD, a traumatic injury, or cancer.
PAD is the leading cause of amputation in people age 50 and older, and accounts for up to 90 percent of amputations overall. Normally, surgeons treat advanced PAD through other methods, like controlling infection using antibiotics and draining or removing any infected tissue as well as performing surgery or other procedures to increase the blood flow to the affected area. However, if these treatments do not work, amputation will remove a source of major infection and may be necessary to save your life.
A traumatic injury, such as a car accident or a severe burn, can also destroy blood vessels and cause tissue death. As a result, infection if not adequately treated, can spread through your body and threaten your life. Your medical team will make every effort to save your limb by surgically replacing or repairing your damaged blood vessels or using donor tissue. However, if these measures do not work, amputation can save your life. Traumatic injuries are the most common reason for amputations in people younger than age 50.
Your physician may recommend amputation if you have a cancerous tumor in your limb. You may also receive chemotherapy, radiation, or other treatments to destroy the cancer cells. Depending upon the particular circumstances, these treatments can shrink the tumor and may increase the effectiveness of your amputation.
Am I at risk for complications during amputation?
If you have other conditions, like diabetes or heart disease, you have a higher risk of complications from an amputation. Having a very serious traumatic injury also increases your risk of complications. Above-the-knee amputations can be associated with more risk than below-the-knee amputations, because people who require above-the-knee amputations are more likely to be in poorer health. Depending upon your particular situation, your physician will attempt to save as much of your limb as is possible.
What happens during amputation?
Choosing the incision site is important. If your surgeon removes too little tissue, your wound will not heal because unhealthy tissue remains and the circulation at that level may not be sufficient for healing. To determine how much tissue to remove, your physician will check for a pulse at a joint close to the site. He or she will also compare the skin temperatures in the diseased limb with those in a healthy limb, and note places where the skin appears red, since an incision made through reddish skin may be less likely to heal. Your physician will also check that your skin around the proposed incision point still has sensitivity to touch. Finally, after he or she makes the initial cut, your physician may decide that more of your limb needs to be removed if the edges of your skin do not bleed enough to allow them to heal.
Before the procedure begins, your anesthesiologist will either put you to sleep, called a general anesthetic, or numb your body in the region of the amputation, called a regional anesthetic. You will be connected to machines that monitor your heart rate, blood pressure, temperature, and brain function. When the anesthetic has taken effect and your are not able to feel the pain, your surgeon then cuts into your skin, leaving enough healthy skin to cover your stump for better healing.
When your surgeon then cuts through the muscles, he or she may shape them, to make sure that your stump has a comfortable contour for your artificial limb. Your surgeon also divides and protects your nerves, so that they are not exposed and painful.
During your surgery, clamps are applied to minimize bleeding when the surgeon divides the healthy major blood vessels. Before finishing your amputation, your surgeon will stitch the vessels, and then release the clamps to ensure that all bleeding points are secure.
If you have a traumatic injury your surgeon will remove the crushed bone and other tissue. Your surgeon then will smooth the uneven areas of your bone to prevent pain once you receive your artificial limb. If necessary, your surgical team may then install temporary drains that will drain your blood and other fluids.
When your surgeon has completely removed all of the dead tissue, sometimes depending upon the circumstances, he or she may decide to leave the site open (open flap amputation) or to close the flaps (closed amputation). In an open flap amputation, your skin remains drawn back from the amputation site for several days so your surgical care team can clean off of any questionable or infected tissue. Once the stump tissue is clean and free of infection, the skin flaps are sewn together to close the wound, a procedure called delayed closure. In a closed amputation, the wound is sewn shut immediately. A closed amputation is usually done if your surgeon is reasonably certain that the chance of infection is small.
Your surgical care team may place a stocking over your stump to hold drainage tubes and wound dressings, or your limb may be placed in traction, or a splint, depending upon your particular situation.
If your condition permits, ideally, you will receive physical therapy soon after your surgery. Physical therapy includes gentle stretching for the first 2 or 3 days. Later, you will perform exercises, such as getting in and out of your bed or in and out of your wheelchair. Eventually, you will learn how to bear your weight on your remaining limb.
Depending upon your particular situation, you may also begin to practice with your artificial limb as early as 10 to 14 days after your surgery, but this depends upon your comfort and wound healing progress.
You may experience phantom pain (a sense of feeling pain in your amputated limb) or other emotional concerns, such as grief over the lost limb, after surgery. If this is the case, your physician can recommend counseling or drug therapy, as appropriate.
Are there any complications?
You may have complications following any surgical procedure. Complications that occur specifically from amputation include a joint deformity called contracture, a severe bruise called a hematoma, death of the skin flaps (necrosis), wound opening from poor healing, or infection. Your surgeon or physician can treat all of these complications. Rarely, you may need to undergo further surgical treatment or another amputation.
What can I do to stay healthy?
If your wound has healed well and your artificial limb fits you, your amputation should cause you minimal long-term medical concerns. However, if you have PAD, amputation does not stop plaque from building up in your remaining arteries. To prevent hardening of the arteries from affecting other parts of your body, including your heart, you should consider the following changes:
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Eat more foods low in saturated fat, cholesterol, and calories |
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Exercise regularly |
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Maintain your ideal body weight |
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Avoid smoking |
You can learn how to adapt to having an artificial limb, including getting regular exercise, with the help of physical therapy. Studies have found that amputees who engage in regular physical exercise feel better about themselves than those who are more sedentary. Also, people who recover from an amputation are more likely to have greater job satisfaction, possibly because of changes in their attitudes regarding life goals.
1. What are Limb Loss and Limb Differences?
Limb loss generally refers to the absence of any part of an extremity (arm or leg) due to surgical or traumatic amputation. The term, Limb Differences, is used in reference to the congenital absence or malformation of limbs.
Click here to view a list of amputation related definitions. 
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2. How frequently does it occur in the population?
There were 1,285,000 persons in the U.S. living with the limb loss (excluding fingers and toes) in 1996. The prevalence rate in 1996 was 4.9 per 1,000 persons. The incidence rate was 46.2 per 100,000 persons with dysvascular disease, 5.86 per 100,000 persons secondary to trauma, 0.35 per 100,000 secondary to malignancy of a bone or joint. The birth prevalence of congenital limb deficiency in 1996 was 25.64 per 100,000 live births. The prevalence rate is highest among people aged 65 years and older ~ 19.4 per 1,000. 
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3. What causes Limb Loss and Limb Differences?
Limb loss can occur due to trauma, infection, diabetes, vascular disease, cancer and other diseases. The causes of congenital Limb Differences are frequently unknown. In the past, many cases of Limb Difference were attributed to the use of drugs, such as thalidomide by the mother during pregnancy. 
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4. How can I reduce the risk of amputation?
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Practice good foot hygiene and care, especially if you are diabetic.
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Stop smoking, or don't start.
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Practice good safety habits when operating machinery (lawnmowers, etc.)
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Reduce the risk of limb deficiencies in your unborn child by taking medications only when absolutely necessary and under your doctor's supervision.
Back to Top5. Are there increased risks for other health problems?
Limb Loss is more often the result of, rather than the cause of other health problems. Since the loss of a limb can result in decreased activity, the risk of health problems associated with a sedentary lifestyle may be increased. Residual limb and phantom pain, as well as skin problems associated with prosthesis use are also common. 
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6. What is involved in caring for people with Limb Loss and Limb Differences?
Care for a person who has undergone amputation, will depend greatly upon his or her overall health and strength. Persons who are candidates for prosthesis use will make several visits to their prosthetic facility to obtain a correctly fitting device. Physical/occupational therapy or gait training may be needed to facilitate successful use of prostheses and other assistive devices to regain independence. Some new amputees may also need professional assistance with emotional adjustment to limb loss. Amputees whose health does not permit prosthesis use may require more assistance with mobility and transfers.
Vocational Rehabilitation (VR) is a nationwide program that helps people with disabilities find employment, whether they simply need a job to pay the bills or and find more meaningful, long-term careers. VR not only benefits people with disabilities but also trains workers for jobs that need to be filled.
Many, though not all, people with disabilities can use VR services. People need to apply before VR can determine if they are eligible for (can get) services. In order to use VR services, you must:
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Be legally eligible to work in the United States. This means that you must prove that you are a citizen of the United States, usually by showing your driver’s license, Social Security card and at least one other form of ID, such as a birth certificate or passport.
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Have a physical, mental or emotional disability that keeps you from finding or keeping a job.
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Be willing and able to work.
Once accepted into VR, you are assigned a counselor who works with you. He or she will help you choose a VR program. There are four types.
1. Vocational Counseling & Guidance. In this program, you work individually (alone) with a counselor. He or she offers support to help you reach your career and job goal. This starts with an assessment of your work potential, including:
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Your disability, education, and social or family situation
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Your knowledge, skills, abilities, and interests
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Your work history, habits, and tolerances (your ability to meet the physical demands of a job)
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Types of help or assistive technology you will need in the workplace
VR Services . After an assessment of your work potential, you and the counselor choose which services will help you get a job and find a meaningful career. These services can include:
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Medical, psychiatric, social, and psychological a ssessments. These help identify your strengths (what you are good at) and limitations (areas where you need help.)
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Vocational assessment. This looks at your interests, readiness for work (whether you are ready to work now or will be soon), skills, and local job opportunities.
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Counseling and guidance. This refers to how you and the counselor work together.
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Restoration. This means healthcare treatments to increase your work potential. This could include corrective surgery, orthotics/prosthetics, mobility aids or assistive devices such as glasses or hearing aids.
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Job preparation. VR offers volunteer experiences, on-the-job training, and education to help you get ready for work.
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Support services. This can include help paying the costs of transportation, tools, equipment, or independent living.
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Job placement. This service helps you find a job suited to your interests and abilities.
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Independent living service. This can be help with daily living tasks that affect whether or not you can work. Independent living services may include help using community services, managing money, or planning how you use your time.
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Assistive technology services. This service looks at types of equipment you need for work.
3. Training & Education. VR offers many types of training that helps people get back to work. This includes:
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On-the-job training. This means paid training under supervision in a normal work environment, learning to use the equipment, documents or materials that you will use when you are ready to work without supervision.
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Self-employment. This means having your own business, rather than working for others. Self-employment is often a good choice for people with disabilities.VR can help research different types of businesses, provide advice from consultants, and help pay the costs of starting a business or buying equipment.
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Supported employment. This is on-the-job help for workers or their employers.
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Short-term vocational training. This includes training programs to help people en ter the job market quickly. Training can be just a few hours or take up to two years.
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College education . VR can help pay college costs beyond financial aid from the school.
. Job Placement. VR is not an employment agency. You will need to look for a job just like everyone else. But VR can help you find job leads, fill out applications, write a resume, and practice for job interviews. It can also help you deal with work-related disability issues such as what to say about your disability or how to ask for needed changes in job duties.
How to learn more: