Amputation 

There are approximately a half a million people today living with an amputation.  Each year, another 20,000 people join that group. There was a time when amputees were limited in their ability to return to a productive life and frequently discriminated against.  However, in the past 20 years, advances in surgical techniques, prosthetic devices, and rehabilitation programs have enhanced the recovery of amputees.  After an amputation, patients are able to get up out of bed more quickly, participate in their personal maintenance sooner, and return to active lives. 

Injuries are most often the cause of amputation.  Poor circulation to the extremities, such as in diabetes or atherosclerosis, is the next leading cause of amputations.  Cancer may also result in a necessary amputation to rid the body of the tumor. 

The goal of an amputation is to leave as much of the extremity as possible, while removing all of the injured or unhealthy tissue. The remaining tissue will be shaped into a stump that will accommodate being fitted with a prosthesis. 

Postoperative goals for the patient with an amputation include: 

• Relief from the original problem that caused the amputation 
• Appropriate pain management 
• Obtain maximum rehabilitation goals with or without a prosthesis 
• Successful adaptation to the change in their body image 
• Positive lifestyle adjustments 

Much of the postoperative recovery will depend on the patient's emotional strength, family and social support, and overall health condition.  These factors should all be addressed before surgery, to better prepare the patient for the necessary adjustments. 

Physicians may use a variety of prosthetics.  However, some patients may not have the physical strength or medical condition that would be benefited by a prosthesis. The physician will discuss the situation with the patient before surgery and develop a course of action at that time. 

If a prosthesis is to be fitted, there are two choices regarding its application: 

• An immediate postoperative prosthesis is fitted during surgery, as soon as the amputation has been completed. This prosthesis may need to be adjusted periodically after surgery as the swelling from surgery decreases. 
•  A delayed prosthesis can be applied days or weeks after surgery, once the postoperative swelling has stopped and  the stump has healed.  In this case, a temporary prosthesis will often be applied soon after surgery to help the patient begin to adjust to using a prosthesis. 

Postoperative warning signs the patient needs to be alert for: 

• Redness, swelling, or drainage from the stump, indicating possible infection 
• Muscle contractures - the muscles in the extremity will stay flexed and shortened and the patient will have difficulty with movement or they may be unable to straighten the limb 
• Changes in stump size or shape, which will cause the prosthesis to fit incorrectly, resulting in damage to the skin and stump 
• Difficulty adjusting to the change in body image and lifestyle changes 

The patient will be educated about all of the issues regarding Postoperative recovery before the surgery.  In the case of an emergency amputation, where there may be little time, these concerns will be addressed immediately after surgery.