Lower Extremity Amputation: A Life Defining Loss

Introduction

A leg, foot, or toe removal from the body is referred to as lower limb amputation. These parts are known as the lower extremities of the body. Amputations can be a result of surgical removal or as a result of physical trauma. Lower extremity amputation is resorted to saving life due to ischemic (poor blood supply area), infected, necrotic (dead area), or unresectable tumors (tumors that cannot be removed) sometimes. More than half of all amputations are caused by peripheral vascular disease (disrupted blood supply to extremities), either by itself or in conjunction with diabetes mellitus. Trauma is the second most common cause of lower limb amputation.

What Are the Terms Used in Lower Limb Amputation?

• Major Amputation - Any amputation carried out above the ankle is major.

• Foot Amputation - Amputations below the ankle are considered foot amputations.

• Primary Amputations - These are carried out without effort to save the limb. Efforts to save limp include revascularization (increase in the blood supply of the affected area), bone repair, or soft tissue coverage.

• Secondary Amputations - These are carried out after a failed revascularization attempt.

• Traumatic Amputation - It is described as limb loss due to an incident.

What Are the Indications for Lower Limb Amputation?

• Trauma - It is a common reason for limb amputation.

• Malignant Tumors - Malignant tumors tend to spread from the original site to other body parts and necessitate removal if it occurs in the extremities.

• Infection and Nerve Injury - Limb removal becomes necessary when the underlying cause cannot be corrected.

• Peripheral Vascular Insufficiency - When the blood supply to the extremities cannot be regained, the area becomes necrosed (dead). Infection from one area can spread to another region, so amputation becomes necessary.

• Congenital Disabilities - Some defects present from birth cannot be cured and require limb amputation.

• Osteomyelitis - A severe illness caused due to bacterial infection of the bone.

• Gas Gangrene - Accumulating gas in the extremities necessitates surgical removal of the leg.

What Are the Levels of Lower Limb Amputation?

Depending upon the site of amputation, it is divided into the following:

• Transfemoral - Above knee amputation.

• Disarticulated Knee - Amputation occurs at the level of the knee.

• Transtibial - Below knee amputation.

• Disarticulated Ankle - Amputation at the level of the ankle.

• Syme Amputation - Amputation occurs at the ankle joint, but the heel pad is saved.

• Foot Amputation - Amputation of part of a foot.

• An amputated toe or transmetatarsal amputation

What Is Above-Knee Amputation?

An above-knee amputation (AKA) occurs when the thigh bone is amputated above the knee joint. Transfemoral amputation is another name for this kind of amputation. The amputation most frequently occurs in the middle of the thigh bone. The femur (bone of the thigh) makes up the residual leg; there is no knee joint. An AKA may cause the hamstrings (tendon in the back of the knee) and quadriceps (the large muscle in the front thigh) to lose a substantial amount of muscular control. Using a prosthesis (an artificial limb) becomes difficult in this type.

What Is Below-Knee Amputation?

Amputation through the shin bone (tibia bone, most giant two bones of the leg) is referred to as a below-knee amputation (BKA), otherwise known as transtibial amputation. BKA is the most frequent amputation, which carries a lower risk of major post-operative complications than a transfemoral amputation. The knee joint is spared in a BKA, and fitting a prosthetic limb is more successful.

What Is Amputation of the Hemipelvis?

The hip joint and a portion of the pelvis are amputated in a hemipelvis amputation. Transpelvic amputation is another name for this kind of amputation. It is typically carried out due to trauma or malignant (spreading cancer) growth. Walking is challenging following a hemipelvis amputation since attaching the prosthesis becomes impossible without a residual limb. However, the doctor and physical therapist can work to determine the best device for a patient to enhance walking abilities.

What is An Amputated Toe?

The leading cause of toe amputations is typically a low blood supply to the toe, which occasionally progresses to gangrene (dead area). Physical therapy helps in rehabilitation but is rarely required after this kind of amputation. But physical therapy may be used occasionally if functional mobility is restricted.

What Is Partial Foot Amputation?

When a portion of the foot is severed, it is called partial foot amputation. Transmetatarsal amputation is another name for this procedure. A person can have a high level of functional mobility after a partial foot amputation since muscle attachments are preserved throughout the procedure. In addition, this kind of amputation preserves the balance and foot contour, which can aid in preserving the natural gait.

What Is Disarticulation?

A joint amputation is referred to as disarticulation. With the removal of the shin bone, the knee joint is preserved. Walking may be more accessible as disarticulation amputation in youngsters aids in maintaining the growth of bone plate.

What Are the Preoperative Training Programs Before Lower Limb Amputation?

1. Limb movement improves circulation and prevents thrombosis (blood clotting) after surgery.

2. Deep breathing, coughing, and postural drainage (improve secretion release) prevent chest complications and maintain joint flexibility. It also boosts the flexibility of the shoulder girdle, pelvis, and other parts of the body.

3. Instructing the patient on how to place the limb in bed.

4. Teach the patients to stand on one leg, balance, and monitor wheelchairs.

5. Psychological comfort is crucial.

What Is Postoperative Care After Lower Limb Amputation?

1. Close monitoring of patients is required to avoid thrombosis and chest complications.

2. Contracture (muscle becomes stiff and short) and deformity avoidance:

• The most frequent form of contracture is knee flexion contracture can be avoided by situating an amputated limb correctly and using passive limb movement.

• Preservation of flexibility and strength.

3. The patient can be moved around in the bed by raising the body on the arms.

4. The benefit of push-up exercise is that it helps to build the upper-limb muscles, which are essential for using ambulation aids in the future.

What Are the Complications of Lower limb Amputation?

• Blood clots.

• Edema (fluid accumulation in the operated area).

• A poor recovery.

• Wound infection.

• Pneumonia (lung infection).

• Phantom limb (pain in the limb even after removal).

• Deep vein thrombosis (DVT) or the formation of a blood clot in lower leg veins that can travel to the lungs and cause blockage.

• Ulceration on a stump.

• Necrosis of the operated area.

• Joint rigidity.

• Osteomyelitis (bone infection).

• Osteoporosis (weakening of bone).

Conclusion

The restoration of mobility and limb function depends on the type of amputation. Therefore, assessing the patient's nutritional state during surgery is essential for better wound healing. After amputation, the patient should try to reduce edema (fluid accumulation), improve vascular inflow, and eradicate bacteremia (bacteria in the blood). Antibiotics should be used when needed.

Surgical operations and rehabilitation must be synchronized. A multidisciplinary approach is used in modern amputee management to handle these extensive challenges. Each situation involves unique medical, surgical, social, rehabilitative, prosthetic, and economic considerations. Amputation surgery includes preoperative, surgical, and short-term and long-term post-operative objectives.