Your vascular surgeon has probably recommended this operation for one of the following reasons:
The blood supply to your foot is very poor, because the arteries of the leg have become very narrow or are completely blocked. This condition is quite serious, because the foot cannot survive and will make you feel very unwell. You may have developed severe pain in your foot waking you at night or even ulcers and black areas in the toes, foot or lower leg. Your physicians have come to the conclusion that your leg circulation is not possible to be improved and so an amputation is necessary.
Your are a diabetic or suffer from chronic renal failure, and you have have developed a very serious infection in a large area of the toes, foot or even the lower leg. This condition will make you feel very unwell and will threaten your life. In many cases such an infection cannot be managed with antibiotics alone and an amputation is necessary.
You will usually be admitted to the hospital one or two days before surgery so that there is enough time for the necessary investigations (blood tests, chest x-ray, electrocardiography, echocardiography etc) to be done. In many cases, a special x-ray of your arteries (arteriography) will have usually been performed to see whether there was any way to improve the leg circulation.
Your physician will generally require that 2 units of blood are available for you. In Greece, you need to personally liaise with the Blood Bank of your hospital in order that blood is secured for you.
The physician will have probably asked you to discontinue for a few days (if you take) any anticoagulant, like Warfarin or Sintrom, or antiplatelet drugs like Clopidogrel (Iscover, Plavix) or Aspirin, in order to reduce the risk for bleeding during the operation.
When you are admitted, it will be quite useful to bring with you all medications you are on. Your medical history will be recorded. Later, your vascular surgeon and the anaesthetist who will put you to sleep will visit. They will explain certain aspects of the procedure and of the immediate postoperative care. If you have any questions regarding the operation, you may ask the doctors then. You will be asked to sign a form confirming that you understand why the procedure needs to be performed, the risks of the procedure and that you agree to the surgery.
The first part of any operation is the administration of anaesthesia. Your operation will be performed either under general anaesthesia (injection of the anaesthetic through an IV in your arm, which will put you to sleep within a few seconds) or under regional anaesthesia (insertion of an epidural catheter in your back to provide pain relief during and after the operation). Occasionally combined anaestesia may be administered. A urinary catheter will be placed in your bladder to monitor your urine output.
The amputation stump will be closed with either Nylon stitches or metal clips and will be bandaged. The sutures will usually be removed 15-20 days after the operation.
Following the operation you will return to your normal ward and you will be given all your fluids by a drip until you are able to eat and drink. The nursing and medical staff will try to keep you free of pain and will explain you the way. It is common to experience pain that feels to be a part of the leg that has been removed (phantom limb pain), but this can be helped with medication and rapidly disappears. Certain pain-killers (opioids) favour constipation and you may need some laxative (syrup, suppositories, enema), while drinking plenty of fluids will help.
The various catheters will gradually be removed and you will become more mobile until you are fit enough to go home. You will be visited by the physiotherapist who will help you with with your mobility, and even with your breathing (if you are thought a high risk for chest infection).
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 help and you will be taught how to use a wheelchair. As your rehabilitation progresses, an appointment will be made at the limb fitting centre to start you walking on a temporary artificial limb (“prosthesis”) and eventually you will have an artificial limb tailored to your needs.
Some alterations may be necessary at your home, especially in the bathroom and the stairs, before you are discharged. Following discharge you will need to continue physiotherapy to become independent with your artificial limb or wheelchair. You will be able to walk again provided you have the motivation and fitness to do so.
Driving may be possible with an amputation, either with an automatic car or with some special modifications. You will probably need some help to bathe at first. You may also need handles or a hoist to get in and out of the bath safely.
As with any operation there is a small risk of a heart attack or stroke or even of dying. Chest infections can occur following this type of surgery, particularly in smokers, and may require treatment with antibiotics and physiotherapy.
Because of the relatively poor blood supply at the level of the amputation, wound healing can sometimes be slow and occasionally it is necessary to perform another amputation higher up in the leg if the wound does not heal.
If the wound becomes infected, appropriate antibiotic treatment will be given, while more rarely a new operation may be required.
You may continue to feel aches and twinges in the wound for several months. If you experience symptoms of phantom limb, as mentioned above, you may be helped with appropriate medication.
Studies have found that amputees who engage in regular physical exercise feel better about themselves than those who are more sedentary. Also, people who recover from an amputation are more likely to have greater job satisfaction, possibly because of changes in their attitudes regarding life goals