Amputations : A very difficult medical decision for patients

The surgical removal of a bodily part, such as an arm or a leg, is known as an amputation.

If you, a friend, or a member of your family has just had or is preparing for an amputation, this article could be useful.

Causes

Any of the following may result in an amputation:

• Diseases include diabetes, blood clots, osteomyelitis, peripheral vascular disease (PVD), and blood vessel disease (an infection in the bones).
• Injuries: Arm injuries in particular. Trauma is a factor in 75% of upper extremity amputations.
• Tumours in the muscles and bones can be removed surgically via amputation.

How to check if you require Amputation?

It could be necessary to amputate if:

• You have a gangrenous limb due to a serious infection in that limb (often as a result of peripheral arterial disease)
• Your limb has suffered severe damage, such as a crush or blast wound.
• Your leg is malformed and only partially mobile and functional.

Risk Factors

The following factors can increase to a higher chance of amputations:

• Blood sugar levels that are high are one factor that increases the risk of amputation.
• Smoking.
• Injury to the feet's nerves (peripheral neuropathy)
• Corns or calluses.
• Foot anomalies.
• Insufficient blood flow to the arms and legs (peripheral artery disease)
• A history of foot ulcers
• An earlier amputation

Preparing before procedure

Before surgery, you will be thoroughly evaluated to determine the best type of amputation and any factors that may affect your rehabilitation, unless you require an emergency amputation.

A thorough medical examination to assess your physical condition, including your nutritional status, bladder function, cardiovascular system (heart, blood, and blood vessels), and respiratory system, is likely to be a part of the assessment.

The health and functionality of your healthy limb will also be examined by the doctor. It is crucial to take care of the healthy limb since removing one limb might put more burden on the remaining limb.

To ascertain how well you will handle the psychological and emotional effects of amputation and whether you will need additional support, it may also include a psychological evaluation.

Your social, work and home environments may be evaluated to see if any adjustments are necessary to help you cope.

The procedure of an Amputation

 How to do an amputation

A general anaesthetic, an epidural anaesthetic, or a spinal anaesthetic can be used to perform amputations while you are asleep (both of which numb the lower half of the body). Depending on what part of your body is being amputated, you may have a choice of anaesthesia.

In most amputations, a section rather than the entire limb is amputated.

Additional procedures can be utilised to assist the functionality of the remaining portion of the limb and lower the risk of problems after the segment of the limb has been severed.

These include shortening and smoothing the residual portion of the limb's bone so that there is enough muscle and soft tissue to cover it. To help strengthen the remaining portion, the surgeon then attaches the muscle to the bones.

Your wound will be closed with stitches or medical staples following the amputation. A bandage will be applied, and a tube may be inserted under your skin to drain any extra fluid. To lower the risk of infection, the bandage will typically need to be left in place for a few days.

Prevention of further Risks

 Taking care of your last limb

It is necessary to protect your remaining "good" leg and foot after having a leg or foot amputated, especially if the amputation was necessary due to diabetes. Your other leg and foot might potentially be in danger.

Avoid wearing uncomfortable shoes, and make sure your remaining foot is being cared for by a qualified healthcare provider, such as a podiatrist. A foot care team should also offer to examine your foot on a regular basis.

Post Surgery Treatments 

Following surgery, you will often get fluids and oxygen via a drip for the first several days as you recuperate in a ward.

During surgery, a short, flexible tube called a urinary catheter may be inserted into your bladder to empty pee. This means that for the first few days following surgery, you will not have to get out of bed to use the restroom. You might be given a bedpan or commode so you can also poop without getting out of bed to use the restroom.

You may experience discomfort at the procedure site, therefore you will be given medicines if you do. If the painkillers are not helping, let a member of your care team know since you could require a higher dose or a stronger painkiller.  

Compression clothing

After surgery, you will observe oedema (swelling) of the stump. This is typical, and it could carry on even after you have been discharged.

A compression garment can reduce oedema and improve the appearance of the stump. It might also strengthen the limb and lessen phantom pain, which is pain that appears to come from a missing limb. 

Rehabilitation

Therapy is a really important part of long-term surgical aftercare.  It may be a protracted, challenging, and unpleasant process, but it is crucial to keep going. You might be able to resume employment and other activities after rehabilitation.

Your rehabilitation programme will be personalised to meet your specific requirements and will work to restore as many of your daily activities as possible.

Returning home and follow-up care

Depending on the type of amputation you had and your overall health, it may take some time before you are ready to return home.

An occupational therapist may make arrangements to visit you at home before you are released from the hospital to determine whether any modifications are necessary to make your house more accessible.

Prosthetic Limbs

You might be able to get a prosthetic limb fitted after an amputation.

Because they need a lengthy programme of physiotherapy and rehabilitation, prosthetic limbs are not appropriate for everyone who has suffered an amputation.

Treatment for stump pain

Medications  

Among the medications that may be used to lessen pain are:

• Non-steroidal anti-inflammatory medicines (NSAIDs), like ibuprofen
• Anticonvulsants like carbamazepine or gabapentin
• Antidepressants like amitriptyline, or nortriptyline, which are effective at relieving nerve pain
• Opioids like codeine or morphine. 
• Injections of corticosteroids or local anaesthetics 

Self-help and complementary therapies

There are a number of non-invasive methods that some individuals may find helpful for pain relief. They consist of:

• You may make your prosthesis more comfortable by changing it so it fits better.
• Using heat or ice packs, rubs, or lotions to administer heat or cold to your limb.
• Massage to activate the muscles and improve circulation.
• It is believed that acupuncture stimulates the nervous system and reduces pain.

Mental effects of amputation

Amputation can have a significant psychological effect. Many people who have undergone an amputation describe feeling loss and mourning afterwards, which is akin to losing a loved one.

Therefore, adjusting to the psychological effects of amputation is sometimes just as crucial as adjusting to physical needs.

For three primary reasons, having an amputation can have a significant psychological impact:

• You must adjust to losing feeling in your amputated leg.
• You must adjust to your severed limb's lack of functionality.
• Both your opinion of your body image and how other people see you has  drastically altered.

Surgery Aftercare

To lower the chance of it getting inflamed or infected, it is crucial to maintain the skin on the surface of your stump clean.

Wash your stump gently with mild, unscented soap and warm water at least once a day (more frequently in warmer weather), then dry it carefully. 

Using soap and warm water, you should also routinely clean the socket if you have a prosthetic limb.

Avoid immersing your stump in water for an extended amount of time when taking a bath since the water can soften the skin on your stump and make it more prone to damage.

Every day, carefully examine your stump for infection symptoms like:

• Warm, swollen, and sensitive skin with fluid or pus discharge

• If you suspect a skin infection, seek advice from your care team.

Complications of Amputation

Complications from an amputation are a possibility, just like with any sort of surgery. Additionally, there is a chance of developing new issues that are directly connected to limb loss. 

The likelihood of problems following an amputation depends on a variety of variables, including your age, the type of amputation you have undergone, and your general health.

Planned amputations provide a lower risk of significant consequences than emergency amputations.

An amputation may result in the following complications:

• Heart issues like heart attacks
• Profound vein thrombosis (DVT)
• Wound infection and slow wound healing
• Pneumonia 
• Pain in the "phantom limb" stump

In rare circumstances, more surgery can be required to fix emerging issues or to ease discomfort. For instance, the damaged cluster of nerves may need to be removed if neuromas (thickened nerve tissue) are suspected of being the source of discomfort.

Being informed that you must have a limb amputated can be distressing and terrifying. Even while adjusting to life following amputation can be difficult, many people find that once they have it, they have a high quality of life.

Please contact the team at MedRec Hospitals for any concerns or questions about Amputation surgery.

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