Thank you to the NHS for the following information which is correct at the time of publishing (September 2018).
An amputation is the surgical removal of part of the body, such as an arm or leg.
This topic may be helpful if you or a member of your family has recently had an amputation or is about to have one.
An amputation may be needed if:
- you have a severe infection in your limb
- your limb has been affected by gangrene (often as a result of peripheral arterial disease)
- there's serious trauma to your limb, such as a crush or blast wound
- your limb is deformed and has limited movement and function
Assessment Before Surgery
Unless you need to have an emergency amputation, you'll be fully assessed before surgery to identify the most suitable type of amputation and any factors that may affect your rehabilitation.
The assessment is likely to include:
- a thorough medical examination – assessing your physical condition, nutritional status, bowel and bladder function, your cardiovascular system (heart, blood and blood vessels) and your respiratory system (lungs and airways)
- an assessment of the condition and function of your healthy limb – removing one limb can place extra strain on the remaining limb, so it's important to look after the healthy limb
- a psychological assessment – to determine how well you'll cope with the psychological and emotional impact of amputation, and whether you'll need additional support
- an assessment of your home, work and social environments – to determine whether any additional provisions will need to be made to help you cope
You'll also be introduced to a physiotherapist, who will be involved in your post-operative care. A prosthetist (a specialist in prosthetic limbs) will advise you about the type and function of prosthetic limbs or other devices available.
If you're having a planned amputation, you might find it reassuring to talk to someone who's had a similar type of amputation. A member of your care team may be able to put you in touch with someone
Finding Your Feet have a private Facebook group which is a great place you can go to get advice or just chat to other amputees. You can join here!
How Amputations Are Carried Out
Please note this section goes into details of the medical process which some might not feel ready to read yet!
Once the limb has been removed, a number of additional techniques can be used to help improve the function of the remaining limb and reduce the risk of complications.
These include shortening and smoothing the bone in your remaining limb so it's covered by an adequate amount of soft tissue and muscle, and stitching the remaining muscle to the bones to help strengthen your remaining limb (a technique known as myodesis).
After the amputation, your wound will be sealed with stitches or surgical staples. It will be covered with a bandage and a tube may be placed under your skin to drain away any excess fluid. The bandage will usually need to be kept in place for a few days to reduce the risk of infection
Recovering After Amputation
After surgery, you'll usually be given oxygen through a mask and fluids through a drip for the first few days while you recover on the ward.
A small flexible tube (a urinary catheter) may be placed in your bladder during surgery to drain away urine. This means you won't need to worry about going to the toilet for the first few days after surgery.
The site of the operation may be painful, so you'll be given painkillers if you need them. Tell a member of your care team if the painkillers aren't working, as you may need a larger dose or a stronger painkiller. A small tube may be used to deliver local anaesthetic to the nerves in your stump to help reduce pain.
Your physiotherapist will teach you some exercises to help prevent blood clots and improve your blood supply while you're recovering in hospital.
You'll notice swelling (oedema) of your stump after surgery. This is normal and it may continue after you've been discharged.
Using a compression garment will help with swelling and the shape of the stump. It may also reduce phantom pain (see stump and phantom limb pain section below) and help support the limb.
You'll be fitted with a compression garment once your wound has healed. It should be worn every day, but taken off at bedtime. You should be given at least two garments, which should be washed regularly.
Physical rehabilitation is an important part of the recovery process. It can be a long, difficult and frustrating process, but it's important to persevere. After rehabilitation, you should be able to return to work and other activities.
Your rehabilitation programme will be tailored to your individual needs and requirements, and will aim to allow you to carry out as many of your normal activities as possible.
You'll work closely with physiotherapists and occupational therapists who will discuss with you what you'd like to achieve from rehabilitation so that some realistic goals can be set.
Your rehabilitation programme will usually start within a few days of surgery, beginning with some simple exercises you can do while lying down or sitting. If you've had a leg amputation, you'll be encouraged to move around as soon as possible using a wheelchair.
You'll also be taught "transfer techniques" to help you move around more easily, such as how to get into a wheelchair from your bed.
Once your wound has started to heal, you may start working on an exercise programme with a physiotherapist in the hospital gym to help you maintain your mobility and muscle strength.
If you have a prosthetic limb fitted (see our prosthetics section below), your physiotherapist will teach you how to use it – for example, how to walk on a prosthetic leg or grip with a prosthetic hand.
Going Home And Follow Up
The length of time it will take before you're ready to go home will depend on the type of amputation you've had, your general state of health and whether your house is ready / accessible.
Before you're discharged from hospital you'll be asked if you have family support. An occupational therapist may arrange to visit you at home to see whether your home environment needs to be adapted to make it more accessible.
For example, you may need a wheelchair ramp or a stairlift. If these types of modifications are required, the issue can be referred to your local social services department. Read about mobility, wheelchairs and scooters and assessing your care and support needs.
It can take several months before you're fitted with a prosthetic limb (if you're suitable for one), so you may be given a wheelchair to help you get around if you've had a lower limb amputation.
You'll probably need to attend a follow-up appointment a few weeks after being discharged to discuss how well you're coping at home and whether you require additional help, support or equipment.
At your appointment, you may also be given details of your nearest amputee support group, made up of both healthcare professionals and people living with an amputation.
Finding Your Feet are here to offer support and help wherever we can.
Phone: 0141 258 4868
To Join Our Online Support Group: No LIMBits
After an amputation, you may be able to have a prosthetic limb fitted.
Although age is not a restrictive factor, prosthetic limbs aren't suitable for everyone who's had an amputation because an extensive course of physiotherapy and rehabilitation is required.
Adjusting to life with a prosthetic limb takes a considerable amount of energy because you have to compensate for the loss of muscle and bone in the amputated limb.
This is why those with a serious health condition, such as heart disease, may not be suitable for a prosthetic limb.
If you're able to have a prosthetic limb, the type of limb that's recommended for you will depend on:
- the type of amputation you had
- the amount of muscle strength in the remaining section of the limb
- your general state of health
- tasks the prosthetic limb will be expected to perform
- whether you want the limb to look as real as possible or whether you're more concerned with function
If it's thought that you would find it difficult to withstand the strain of using a prosthetic limb, a purely cosmetic limb may be recommended. This is a limb that looks like a real limb, but can't be used.
It's possible to have a prosthetic limb that's both physically realistic and functional, but there may have to be an element of compromise between the two.
Preparing To Have A Prosthetic Limb Fitted
If a prosthetic limb is suitable for you, you'll begin a programme of activities while still in hospital to prepare for the prosthetic.
Before a prosthetic limb is fitted, the skin covering your stump may be made less sensitive (known as desensitisation). This will make the prosthetic more comfortable to wear.
Skin desensitisation involves the following steps:
- gently tapping the skin with a face cloth
- using compression bandages to help reduce swelling and prevent a build-up of fluid inside and around your stump
- rubbing and pulling the skin around your bone to prevent excessive scarring
Your physiotherapist will teach you a range of exercises to strengthen the muscles in your remaining limb and improve your general energy levels, so you're able to cope better with the demands of an artificial limb.
Depending on what's available in your local area, it can be several months before you get your first appointment with a prosthetist (specialist in prosthetic limbs).
It's very important to keep the skin on the surface of your stump clean to reduce the risk of it becoming irritated or infected.
Gently wash your stump at least once a day (more frequently in hot weather) with mild unscented soap and warm water, and dry it carefully.
If you have a prosthetic limb, you should also regularly clean the socket using soap and warm water.
When taking a bath, avoid leaving your stump submerged in water for long periods because the water will soften the skin on your stump, making it more vulnerable to injury.
If your skin becomes dry, use a moisturising cream before bedtime or when you're not wearing your prosthesis.
Some people find wearing one or more socks around their stump helps absorb sweat and reduces skin irritation. The size of your stump may change as the swelling goes down, so the number of socks you need to use may vary. You should change the socks every day.
Check your stump carefully every day for signs of infection, such as:
- warm, red and tender skin
- discharge of fluid or pus
- increasing swelling
Contact your care team for advice if you think you may be developing a skin infection.
Caring For Your Remaining Limb
After having a leg or foot amputated, it's very important to avoid injuring your remaining "good" leg and foot, particularly if your amputation was needed because of diabetes. Your remaining leg and foot may also be at risk.
Diabetics must avoid wearing poorly fitting footwear and ensure that an appropriately trained healthcare professional, such as a podiatrist, is involved in the care of your remaining foot. You should also be offered a regular review of your foot by the foot care team.
You can read more about diabetes and foot care here!
Like any type of surgery, an amputation carries a risk of complications. It also carries a risk of additional problems directly related to the loss of a limb.
There are a number of factors that influence the risk of complications from amputation, such as your age, the type of amputation you've had, and your general health.
The risk of serious complications is lower in planned amputations than in emergency amputations.
Complications associated with having an amputation include:
- heart complications – such as heart attack
- deep vein thrombosis (DVT)
- slow wound healing and wound infection
- stump and "phantom limb" pain
In some cases, further surgery may be needed to correct problems that develop or to help relieve pain. For example, if neuromas (thickened nerve tissue) are thought to be causing pain, the affected cluster of nerves may need to be removed.
Stump And Phantom Limb Pain
Many people who have an amputation experience some degree of stump pain or "phantom limb" pain.
Phantom limb sensations are sensations that seem to be coming from the amputated limb. Occasionally, these can be painful (phantom limb pain).
The term "phantom" doesn't mean the painful symptoms are imaginary. Phantom limb pain is a real phenomenon, which has been confirmed using brain imaging scans to study how nerve signals are transmitted to the brain.
The symptoms of phantom limb pain can range from mild to severe. Some people have described brief "flashes" of mild pain, similar to an electric shock, that last for a few seconds. Others have described constant severe pain.
Stump pain can have many different causes, including rubbing or sores where the stump touches a prosthetic limb, nerve damage during surgery and the development of neuromas.
Treating stump and phantom limb pain
Stump and phantom limb pain will usually improve over time, but treatments are available to help relieve the symptoms.
Medications that may be used to help relieve pain include:
- non-steroidal anti-inflammatory drugs (NSAIDs) – such as ibuprofen
- anticonvulsants – such as carbamazepine or gabapentin. This medication can be started prior to your amputation. Please speak to your doctor about this.
- antidepressants – such as amitriptyline or nortriptyline (these medications work directly on the nerves in your leg)
- opioids – such as codeine or morphine
- corticosteroid or local anaesthetic injections
Self-Help Measures And Complementary Therapy
There are several non-invasive techniques that may help relieve pain in some people. They include:
- checking the fit of your prosthesis and making adjustments to make it feel more comfortable
- applying heat or cold to your limb, such as using heat or ice packs, rubs and creams.
- wrapping your limb in a thin blanket and applying a hot water bottle underneath
- massage – to increase circulation and stimulate muscles
- acupuncture – thought to stimulate the nervous system and relieve pain
- transcutaneous electrical nerve stimulation (TENS) – where a small, battery-operated device is used to deliver electrical impulses to the affected area of your body, to block or reduce pain signals
- mental imagery (see below)
Research has shown that people who spend 40 minutes a day imagining using their phantom limb, such as stretching out their "fingers" or bunching up their "toes", experience a reduction in pain symptoms.
This may be related to the central theory of phantom limb pain (that the brain is looking to receive feedback from the amputated limb), and these mental exercises may provide an effective substitution for this missing feedback.
Another technique, known as mirror visual feedback, involves using a mirror to create a reflection of the other limb. Some people find that exercising and moving their other limb can help relieve the pain from a phantom limb.
Psychological Impact Of Amputation
The loss of a limb can have a considerable psychological impact. Many people who've had an amputation report feeling emotions such as grief and bereavement, similar to experiencing the death of a loved one.
Coming to terms with the psychological impact of an amputation is therefore often as important as coping with the physical demands.
Having an amputation can have a considerable psychological impact for three main reasons:
- you have to cope with the loss of sensation from your amputated limb
- you have to cope with the loss of function from your amputated limb
- your sense of body image, and other people's perception of your body image, has changed
Negative thoughts and emotions are common after an amputation. This is particularly true in people who've had an emergency amputation because they don't have time to mentally prepare for the effects of surgery.
Common negative emotions and thoughts experienced by people after an amputation include:
- denial (refusing to accept that they need to make changes, such as having physiotherapy, to adapt to life with an amputation)
- feeling suicidal
People who've had an amputation as a result of trauma (particularly members of the armed forces) also have an increased risk of developing post-traumatic stress disorder (PTSD).
Talk to your care team about your thoughts and feelings, particularly if you're feeling depressed or suicidal. You may need additional treatment, such as antidepressants or counselling, to improve your ability to cope after having an amputation.
Help And Support
Being told you need to have a limb amputated can be a devastating and frightening experience. Adjusting to life after an amputation can be challenging, but many people enjoy a good quality of life once they have managed to adapt.
You may find it useful to join a support group for people living with amputations. Finding Your Feet can offer this, in the form of our Facebook groups and the numerous clubs we run. Our clubs are varied and while some are really good for physical rehabilitation, mobility, strength and fitness, others are centred around gentler activities with the focus being more on social inclusion and providing a network that encourages and enables amputees to come together and meet one another. We also have our in-house Counsellor Michelle available who can work with you on a one to one basis either over the phone or face to face, depending on your own preference and locality. For more information……
Phone: 0141 258 4868
To Join Our Online Support Group: No LIMBits
- Rotating ferrules for crutches or sticks can really help you change direction and are safer especially in smaller spaces as you don't need to lift the crutch off of the floor just to turn around.
- A pair of traction or anti slip covers for your shoes can be great as the colder weather comes in. Be careful they don't have metal tips though as they could slip in the dry.
- Keep your Prosthetic Centre Number in your Mobile phone contacts.
- A pair of trousers with zip off legs can allow you to change them into shorts easily when having your leg worked on.
- Home automation kits, like Amazon Echo and Hive, can help control devices around the house using your voice or phone, great for moments when you're not as mobile.
- Hand rails around the house are very helpful.
- Always carry a can of WD40 when travelling.
- If your prosthetic is rubbing, try rubbing olive oil on the area.
- Limbo Cast protectors can protect your prosthetic in the shower, great if you're away from home and need to shower and have no chair.
- Wet wipes are great for a quick wipe down.
- A micro fibre towel is ideal to dry off your stump throughout the day, especially on holiday in the sun.
- To cut down excess sweating from your stump, Mitchum deodorant can help.
- If you're an above the knee amputee, dress the leg first then step into it, it's much easier!
- Keep Fairy liquid under the bed, handy if your prosthetic pin gets stuck and you have to slide out of your liner.
- Always carry a shoehorn. Handy for all types of shoes.
- Rubbing your limb can really help with pains, soreness and itching. Using a small rubber spiky massage ball really helps to get into the muscle and prevent cuts if your nails are long
- Gorilla tape (or very strong sellotape), useful to have in case you have to patch a liner or quick repair of something.
- Water proof socks - save getting your prosthetic foot wet.
- Badminton racket handle tape - use this on your crutches handles, it makes them more comfortable to use.
- Elastic laces make getting your shoes on and off quicker.
- Small first aid bag with plasters, tape, gel etc - good to throw into a bag when you're out and about.
- Zombie bag - this is a small bag which contains spare liner, socks, medical stuff, first aid etc, handy to have one packed so you can grab it if you need to go somewhere quickly.
- If you want to try wearing ankle boots or wellies then put a plastic bag over your sock first, then slide your foot into the boot - helps when getting it back off.
- Having any moisturizers or creams that you use in small travel tubs / bottles can be good to take if you're going out.
- Look at getting a JonHen cooling towel - once wet can go very cold quickly which is great for wrapping around a hot limb etc.
- If you use crutches to help get up to the toilet during the night then getting a small bike light and fastening it to the crutches can help you see where you're going without turning on lights and waking everyone up.
Ice and snow can be difficult to walk on for anyone, but even more dangerous for amputees, people with limb difference and people with other physical disabilities. Have a look at some tips below for getting around in the winter.
- Keep up with the weather. Get a good weather app on your phone and plan your trips around that.
- Stay in if you can. This one may seem obvious, but if you don't have to go out and about, then don't! If you have somewhere you have to be, it might be an idea to ask a friend or family member to go along with you, or at least let them know where you'll be.
- Plan ahead. If you use an electric chair, make sure it's fully charged. Think about anything you might need and if you can take it with you.
- Consider extra support. Even if crutches or walking sticks aren't part of your everyday life, now may be the time to use them until the weather improves.
- Get a grip. Your normal shoes may not cut it in certain conditions, so it's a good idea to have a pair with extra grip that you can rely on to reduce the chance of a slip.
- Accessorise. There are plently of additions for crutches, sticks, shoes and chairs out there that are designed to help in dangerous conditions.
- Be wary of all surfaces. Ice and frost can be deceiving, so be wary no matter how safe a surface might seem.
- Don't shy away from support. Asking for help can be tough and we understand why a lot of people don't do it, but if it's the difference between a bad fall or becoming stranded, we really recommend it. It could be as simple as someone waiting around to make sure you don't struggle with a certain area.
- Expect a fall and know how to deal with it. If you're a prosthetic user, you need to know how to fall. If you haven't ever been given this information for your situation, ask your physio or NHS medical professional to teach you. You'll also be able to practice getting back up, but always ask for help if you need it.
- Don't discount your wheelchair. If you're used to walking with prosthetics, going back to your wheelchair can be inconvenient, but it may just offer you the security you need for a few days. Chairs can, however, present their own host of issues in bad weather, so be cautious.