Lower Extremity Amputation
Foot or leg amputation refers to surgical removal of a lower limb and is often caused by poor circulation, diabetes or an uncontrolled infection that has destroyed skin, muscle and other tissue.
Diabetes and peripheral arterial disease are the leading cause of foot and leg amputations in the United States. Many amputations could be avoided with control of blood sugar, ensuring shoes fit properly, daily foot care, and education.
Foot or leg amputation is often the result of a minor injury such as a cut, crack or blister that goes unnoticed and results in an ulcer (wound). The presence of diabetes and peripheral arterial disease make these wounds difficult to heal. People with diabetes often have nerve damage that reduces the ability to feel. This inability to feel makes it hard to notice that a wound has occurred so the wound goes untreated. Left untreated infections can enter these wounds and spread causing irreversible damage that may result in amputation. The following scenario is often seen leading to amputation:
- Shoes that don't fit well cause a blister
- Blister isn't noticed and is left untreated causing it to burst open creating a wound
- Germs enters the open wound and it becomes infected
- Poor circulation to the wound limits the body's ability to fight off infection
- Untreated wound gets bigger and deeper damaging muscle and surrounding tissue
- Untreated infection spreads to the bone (osteomyelitis)
- Infection kills tissue (gangrene)
- Medicine (antibiotics) and wound care fail to cure the infection
- Amputation is the only option to keep the gangrene from spreading
- Patient is scheduled for a lower extremity amputation
If an amputation is required, the two main goals are to remove unhealthy or infected tissue and to create a cone shaped stump that will heal and be amenable to an artificial limb.
In the days leading up to your operation:
- You will probably continue to take all major medications; check with your surgeon
- The night before surgery do NOT eat anything after midnight. You may have SMALL sips of CLEAR liquids (black coffee, black tea, apple juice, water) up to four hours before your procedures.
The day of your operation please:
- Arrive at hospital and check in at the Ambulatory Surgical Unit (next to the emergency room) at the time indicated
- Leave all valuables and medications at home
- Bring a complete list of all medications you take including the dose, time of day you take them, and the time you took the last dose
Following your surgery, you'll stay in the hospital for several days. We've developed a patient picture pathway providing you with a general overview showing how your stay in the hospital will progress. Being actively involved in your post operative care and making sure you follow through with the items outlined on the picture pathway will promote the quickest possible recovery and help to ensure the best possible outcomes!
As you get ready to be discharged from the hospital, deciding what type of rehabilitation program you'll participate in is a key decision and will have a long lasting impact on your recovery and return to independence. To choose the best rehabilitation facility for you or your loved one, it is important to know that there are different kinds of facilities from which to choose. Maybe you've even heard the terms used to refer to those choices - skilled nursing (or sub-acute rehabilitation) facilities, nursing homes, assisted living centers, and acute rehabilitation hospitals. Although all of these facilities have rehabilitation professionals on staff, only one specializes in rehabilitation - the acute rehabilitation hospital.
Because their primary focus is rehabilitation, acute rehabilitation hospitals like New England Rehabilitation Hospital of Portland provide a level of care distinctly different from other facilities that offer rehabilitation services.
Acute rehabilitation hospitals:
- Provide more intensive therapeutic services
- Have more physician specialists with expertise in treating patients with disabling injuries/illnesses
- Have a higher percentage of registered nurses skilled in rehabilitation nursing
- Have the most highly trained therapists
- Offer the most innovative therapeutic programs
- Have the most up-to-date technologies and facilities
- Provide comprehensive patient/family education
When considering your rehabilitation options, the most important question to ask is, "Which level of care best meets the patient's needs?" For more information, see What To Look for in a Rehabilitation Facility.
New England Rehabilitation Hospital of Portland (NERHP) provides acute rehabilitation, a level of care quite different from other facilities that offer rehabilitation services. That difference is evident in several important ways:
As an acute rehabilitation hospital, NERHP has an extensive medical staff trained to provide the comprehensive medical management needed to help patients achieve optimal health and independence. Our medical staff is comprised of:
- Full-time Internal Medicine and Physical Medicine & Rehabilitation physicians
- Numerous physician specialists, including pulmonolgists, orthopedists, cardiologists, and neurologists
- Full-time neuropsychologists, nurse practitioner, and physician assistant
Because NERHP has an extensive hospital-based medical staff:
- Our doctors assume total responsibility for patient care 24 hours a day, seven days a week.
- Each patient is routinely evaluated by an Internal Medicine physician as well as a physician who specializes in Physical and Rehabilitation Medicine. In fact, generally, patients are seen six times a week by a member of our medical staff; thus, potential medical complications are identified quickly so that treatment is provided before those complications develop.
- When patients need other specialized medical care, a physician specialist (i.e., pulmonologist, neurologist, cardiologist, orthopedist) is readily available to provide that care.
Acute rehabilitation hospitals provide a higher level of therapeutic services than other rehabilitation facilities. Although the intensity and duration of therapies depend on the patient's needs and capabilities, NERHP is equipped to provide each patient with therapeutic services:
- Seven days per week
- For three or more hours a day
The intensity and availability of therapeutic services provided through acute rehabilitation result in a high level of functional outcomes and discharges to the community. In fact, patients admitted to a rehabilitation hospital are three times more likely to go home than those admitted to a skilled nursing facility.
As with medical and therapeutic services, acute rehabilitation hospitals provide a distinctly different level of nursing care than other kinds rehabilitation facilities. At NERHP:
- A 24-hour team of registered nurses and personal care assistants assess and attend to each patient's needs. They work in partnership under the primary nurse-model, which assures continuity of care.
- Patients receive six hours of nursing care each day (compared to four or less hours per day per patient at skilled nursing facilities). This high level of nursing care leads to early recognition/prevention of medical complications, more out-of-bed hours, and increased opportunities for patient- family education.
- Fifty percent of nursing staff are registered nurses (compared to thirty-five percent at skilled nursing facilities). This increased level of RN's ensures that medically complex patients will be treated safely and efficiently.
- Twenty-five of staff nurses are certified registered rehabilitation nurses. Trained to meet the unique needs of individuals with disabling injuries and illnesses, these nursing specialists provide holistic patient care and patient-family education, facilitate carry-over from therapy, and reinforce patient goals.
- NERHP is one of the few facilities that does not utilize nursing agency staff. All NERHP nurses are employees of the hospital, an indication of job satisfaction and commitment to patient care.
We recognize that there are many factors which may influence your decision regarding post hospital care and rehabilitation. Our expert team of discharge planners will be meeting with you while in the hospital to make the decision which is best for you and your loved ones.
Throughout your hospital stay and after discharge to a rehabilitation unit, your experienced team will work with you and will focus on several areas.
- Wound care and stump care: Caring for your wound and stump begin immediately after surgery. Your health care team will provide specific instructions on caring for the incision site and stump.
- Preventing infection: The area should be kept clean and dry. Symptoms of infection such as fever, excess drainage or shaking chills should be reported to your doctor immediately!
- Pain. Phantom limb sensation is the feeling that the amputated limb is still there and that the area is numb or tingly. It is a common after amputation. Phantom limb pain is the term used when this sensation is painful. Management of pain or discomfort is personalized to each patient and a top priority for our dedicated team of nurses, doctors, physical and occupational therapists.
- Shaping the leg stump and controlling swelling: A cone shape is best to fit an artificial limb to. Your health care team will use elastic bandages and/or rigid or semi-rigid dressing to protect the residual limb from damage and to keep swelling to a minimum. Using the elastic bandages and dressings and keeping the stump elevated promotes healing and decreases swelling.
- Prevention of contractures: Your health care team will teach you how to keep the joints moving so they do not get stuck in one position. A physical therapist will work with you and teach you exercises that will keep the joint moving, allow you to straighten the joint while avoiding damage to stitches.
- Physical and Occupational Rehabilitation: Physical and Occupational Rehabilitation specialists will begin working with you the day following surgery. Therapy includes but is not limited to
- Transfer training - learning how to move from the bed to chair etc
- Balance training - learn how to adjust for the change in the body's center of gravity
- Standing tolerance - increasing the amount of time you can stand
- Fall prevention - learning how to prevent falls and learning how to land safely in case of a fall as well as how to get back up
- Range-of-motion exercises to keep joints from getting stiff
- Gait training - walking
- Progress from parallel bars to walker to crutches to cane to walking without an assistive device, if possible
- Progress from walking on smooth surfaces to uneven surfaces and obstacles such as curbs
- Stair climbing
- Prosthetic fitting: You'll work with a specialist called a prosthetist. Your prosthetist will work with you to fit the artificial limb, custom shoe or any other orthotic device you may need. You may have a "temporary" prosthetic limb used following surgery with a permanent prosthesis fitted later.
- Keep the opposite leg healthy to prevent amputation! Prevention of complications in the amputated limb as well as keeping the other leg healthy is important to prevent further limb loss! Both at Maine Medical Center and at the rehabilitation unit you go to after hospital discharge, we'll work with you to provide:
- Education, education, education!
- Social and emotional concerns. An amputation can be a very traumatic experience causing difficulties with psychological and social adjusting. Our expert staff are here to help you adjust to this time in your life. Typical reactions include feeling depressed, sad, fear, increased family stress, and a feeling of low self esteem. In addition, there are many support groups such as the Amputee Coalition of America that provide support and the opportunity to interact with people who have shared similar experiences.
If you're faced with the possibility of amputation, our physicians will be happy to answer any questions you have. You may wish to ask your doctor some of the following questions to help you make a decision about foot or leg amputation:
- Can anything be done to avoid the need for an amputation?
- What are the risks and benefits of having surgery now versus waiting?
- How high up my leg do you think my amputation will be?
- How will my pain be controlled?
- Where will I have my rehabilitation after I'm discharged from the hospital?
- Will I be able to use a prosthesis?
- Will I be able to walk again?
- Will I always need to use an assistive device to help me walk?
- What will I need to do at my house to make it a safe place for me?
- What can I do to prevent needing more amputations?
Foot or leg amputation is performed at Maine Medical Center by expert vascular surgeons who work collaboratively with an amputation team to promote the best possible outcomes. Our collaborative team will guide your recovery course to ensure the best possible wound care, stump care, physical therapy, prosthetic training, and counseling to promote a timely return to the highest level of independence possible.