1. Why do I need the operation?
Because you have a blockage or narrowing of the arteries supplying your legs, the circulation to your legs is reduced. This has become so severe that there is not enough blood reaching your lower leg and if left untreated, you will become unwell. Your doctors have decided that it is not possible to improve the blood supply to your leg and so an amputation is necessary.
2. Before your operation
If you are not already in hospital, you will usually be admitted one or two days before your operation in order to allow time for the required tests to be carried out to make sure you are fit for the operation. An x-ray of the arteries (arteriogram) will have usually been performed to see whether there is anything that could have been done to improve the circulation.
3. Coming into hospital
Please bring with you all the medications that you are currently taking. You will be admitted to your bed by one of the nurses who will also record your personal details in your nursing records. Prior to surgery, you will undergo a number of investigations if these have not been performed previously, including a heart tracing, a chest x-ray and blood tests. The Surgeon who will be performing your operation and the anaesthetist will visit you. If you have any questions regarding the operation please ask the medical team.
4. The operation
You will be taken initially to a reception area in the theatre suite, then to the anaesthetic room where you will be given your anaesthetic, and from there into the theatre. You will either be put to sleep (a general anaesthetic) or you will have a tube inserted into your back through which pain killers can be given to numb the lower half of your body. Sometimes you will have this as well as the general anaesthetic to provide pain relief after your surgery. While you are asleep, a tube may be inserted into both your bladder to drain your urine, and into a vein in your arm or neck (or both) for blood pressure measurements and administration of fluid following surgery. The amputation stump will often be closed with a stitch under the skin that dissolves by itself. A clear plastic dressing may be used to allow the stump to be inspected, although bandages or a plaster cast are sometimes used.
The main sites of amputation are; individual toes or forefoot, just below the knee and just above the knee (see fig 1-4).
In general, the level of amputation will depend on how poor the blood supply is to your leg. If possible, below-knee amputations are performed, since it is easier to walk with an artificial limb after the operation. However, many people do well after an above-knee amputation.
5. After the operation
After your operation you will be given fluids by a drip in one of your veins until you are well enough to sit up and take fluids and food by mouth. The nurses and doctors will try to keep you free of pain by giving pain killers by injection via a tube in your back, or by a machine that you are able to control yourself by pressing a button. It is quite common to experience pain in the part of the leg that has been removed (phantom limb pain). This can be helped with medication and should rapidly disappear. As the days pass and you improve, the various tubes will be removed and gradually you will become more mobile until you are fit enough to go home. The physiotherapist, who will visit you before and after your operation, will help you with your breathing (to prevent you developing a chest infection) and also with your mobility. Initially, you will be shown exercises in bed and then you will be encouraged to transfer from your bed to a chair. As your wound heals, the physiotherapist will start you walking with assistance of a temporary artificial limb if possible, if not, you will be taught how to use a wheelchair. Even if you are planning to walk, you may still need a wheelchair temporarily or for long trips. An appointment will be made for you to have an artificial limb fitted at the limb-fitting centre. When dressed, your artificial limb will look quite normal.
6. Going home
Some alterations may be necessary at your home before you are discharged and in some cases it may be necessary for you to move into different accommodation. Following discharge, you will need to continue to attend the physiotherapy department to help you become independent with your artificial limb or wheelchair. If your stitches need removing and this has not been done in hospital, the district nurse will visit you and also check your wound. These days people manage very well on artificial limbs and you will be able to walk again provided you have the motivation and fitness to do so. The physiotherapists, nurses and doctors at the limb-fitting centre will help you.
Driving: May be possible with an amputation, either with an automatic car, or with some special modifications.
Bathing: Once your wound is dry you may bathe or shower, but you will probably need help at first. You may also need handles or a hoist to get in and out of the bath safely.
Sexual activity: You may resume sexual activity after 2 to 3 weeks if you feel comfortable to do so.
Because of the poor blood supply, wound healing can sometimes be slow and very occasionally it is necessary to perform another amputation higher up the leg if the wound does not heal. The wound can become infected and, if so, will require treatment with antibiotics. Aches and twinges in the wound are common and may continue for several months. Chest infections can occur following this type of surgery, particularly in smokers, and may require treatment with antibiotics and physiotherapy.
8. What can I do to help myself?
If you were previously a smoker, you must make a sincere and determined effort to stop as this may damage the circulation in your other leg. It is also important that you do not put on weight, as this will make walking with your artificial leg more difficult.