Patient education: Amputation, below-the-knee (The Basics)

What is amputation? — This is surgery to remove a damaged body part. During a "below-the-knee" amputation, or "BKA," some of the lower leg is removed, but the knee joint is kept in place.

You might need a BKA if:

●Your lower leg was severely injured and cannot be fixed.

●You have an infection that might spread unless your lower leg is removed.

●You have very poor blood flow to your lower leg.

●You have a tumor in your lower leg.

●You have certain deformities that cannot be fixed or prevent you from using your leg.

The doctor will decide what part of your leg needs to be amputated based on your condition. They will keep as much healthy tissue as possible.

The part of the leg that remains after amputation is sometimes called a "stump." After surgery, you might be able to use a prosthetic device. (A prosthetic is an artificial body part.)

How do I prepare for amputation? — In some cases, an amputation is an emergency surgery. In others, the doctor can schedule a time for your surgery. If you can schedule it, the doctor can help you prepare for what life will be like after. They will talk with you about prosthetic devices and your options.

Before your procedure, your doctor will do an exam. The doctor or nurse will tell you if you need to do anything special to prepare. They might send you to get tests, such as:

●X-rays or other imaging tests – These create pictures of the inside of the body.

●Lab tests

Your doctor will also ask you about your "health history." This involves asking you questions about any health problems you have or had in the past, past surgeries, and any medicines you take. Tell them about:

●Any medicines you are taking – This includes any prescription or "over-the-counter" medicines you use, plus any supplements you take. It helps to write down and bring a list of any medicines you take, or bring a bag with all of your medicines with you.

●Any allergies you have

●Any bleeding problems you have – Certain medicines, including some herbs and supplements, can increase the risk of bleeding. Some health conditions also increase this risk.

You will also get information about:

●Eating and drinking before your procedure – In some cases, you might need to "fast" before surgery. This means not eating or drinking anything for a period of time. In other cases, you might be allowed to have liquids until a short time before the procedure. Whether you need to fast, and for how long, depends on the procedure you are having.

●Lowering the risk of infection – In some cases, you might need to wash the area with a special soap.

●What help you will need when you go home – For example, you will need to have someone else bring you home or stay with you for some time while you recover. You will need to use a walker, crutches, or wheelchair for a time after surgery until you are able to put weight on your stump.

Ask the doctor or nurse if you have questions or if there is anything you do not understand.

What happens during amputation? — When it is time for the procedure:

●You will get an "IV," which is a thin tube that goes into a vein. This can be used to give you fluids and medicines.

●You will get anesthesia medicines. This is to make sure that you do not feel pain during the procedure. Types of anesthesia include:

•Regional – This type of anesthesia blocks pain in 1 area of your body, such as an arm, a leg, or the lower half of your body. If you get regional anesthesia, you'll get medicines to make you feel sleepy, called "sedatives."

•General – This type of anesthesia makes you unconscious so you can't feel, see, or hear anything during the procedure. If you have general anesthesia, you might get a breathing tube to help you breathe.

●The doctors and nurses will monitor your breathing, blood pressure, and heart rate during the procedure.

●The doctor will remove any tissue on your leg that is damaged, dead, or infected. They will leave the knee joint and as much healthy tissue as possible.

●They will shape the end of the leg with muscles to cushion the ends of the bone. This will also help if you use a prosthetic later.

●In rare cases, the doctor will place a drain to get rid of extra fluid.

●In most cases, the doctor will close your cuts (incisions) and cover them with clean bandages. If the wound was very dirty or the tissue was very infected, the doctor might not stitch the wound closed.

●The doctor will wrap the stump with gauze and an elastic bandage.

●The procedure usually takes between 1 and 2 hours.

What happens after amputation? — After your procedure, you will be taken to a recovery room. The staff will watch you closely as your anesthesia wears off.

As you recover:

●You might feel groggy or confused for a short time. You might also feel nauseous or vomit. The doctor or nurse can give you medicine to help with this.

●If you had a breathing tube, you might have a sore throat. This usually gets better quickly.

●Prop your leg on pillows, keeping it above the level of your heart, when sitting or lying down. This might help lessen pain and swelling.

●The staff will help you get out of bed and start moving around when you are ready.

●You will get medicine to help with pain. You might need other medicines, too.

●When you are ready to eat, you might start with clear liquids. Then, you can start eating as you are able. You might feel better if you start with bland foods.

How long it takes to recover, and what you need to do, depends on your overall condition and the reason for your amputation. If you were able to schedule your surgery, you might spend 1 to 3 nights in the hospital. Most people go to a rehabilitation, or "rehab," facility before going home. At rehab or after you go home, you will work with a prosthetist and a physical therapist (exercise expert).

What are the risks of amputation? — Your doctor will talk to you about all of the possible risks, and answer your questions. Possible risks include:

●Poor wound healing or spread of diseased tissue – This might require amputation of more of the leg.

●Infection

●Bleeding or blood clots

●Developing a "neuroma" where nerves were cut – This is an abnormal mass of nerve tissue.

●Phantom pain – This is a painful feeling that the leg is still there.

●Contracture – This is being unable to straighten the knee properly.

What else should I know? — Before you go home from the hospital, make sure that you know what problems to look out for and when you should call the doctor. Make sure that you understand your doctor's or nurse's instructions. Ask questions about anything you do not understand.

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