Patient Information - Leg Amputation
at QMC and City Hospital, Nottingham
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1. Why do I need the operation?
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| Because you have a blockage or narrowing of the
arteries supplying your legs, the circulation to your legs
is reduced. This has become so severe that there is not enough
blood to keep your leg alive and if left untreated, you will
continue to have pain, if that is the problem, or you may
develop gangrene which could make you very ill. Your doctors have decided that it is not
possible to improve the blood supply to your leg and so an
amputation is necessary. The main sites of amputation are;
just below the knee, through the knee, and through the thigh. In
general this level will depend on how poor the blood supply
to your leg is. If possible, below knee amputations are performed
as it is easier to walk with an artificial limb after the
operation However, many people do well after a thigh
amputation. |
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2. Before your operation.
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| Mr Braithwaite will only perform an amputation if
the person who needs it is in agreement. To help make the
decision, Mr Braithwaite will discuss all the options with you,
he will arrange for you to see a nurse who specialises in the
treatment of amputees. Unless you are very ill and need an
amputation as an emergency, Mr Braithwaite will allow you as
much time as you wish to make a decision. When you have asked to
have the operation, Mr Braithwaite will ask one of his team to
arrange the operation. When possible we will arrange for you to
have an epidural which is a pain killing drip into your back. If
this is done before the operation day then some of the side
effects of the operation can be improved. |
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3. Coming into hospital.
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| If you are not already in hospital, please bring with you all the medications that you
are currently taking. You will be admitted to your bed by
one of the nurses who will also note down your personal details
in your nursing records. Prior to surgery you will undergo
a number of investigations, if these have not been performed
previously, including a heart tracing, a chest x-ray and blood
tests. You will be visited by the Surgeon who will be
performing your operation and also the doctor who will give you
the anaesthetic. If you have any questions regarding the
operation please ask the doctors. |
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4. The operation.
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| You will be taken initially to a reception area in
the theatre suite, then to the anaesthetic room where you
will be given your anaesthetic, and from there into the theatre.
You will either be put to sleep (a general anaesthetic) or
you will have a tube inserted into your back through which pain
killers can be given to numb the lower half of your body
(epidural). For some people, Mr Braithwaite would like to have
the epidural working for two days or more before the operation. Whilst you are
asleep, a tube may be inserted into your bladder to drain
your urine, and into a vein in your arm or neck (or both) for
blood pressure measurements and administration of fluid
following surgery. The amputation stump will often be closed
with a stitch under the skin that dissolves by itself. The stump
will be bandaged at the end of the operation. |
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5. After the operation.
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| After your operation you will be given fluids by a
drip in one of your veins until you are well enough to sit
up and take fluids and food by mouth. The nurses and doctors
will try and keep you free of pain by giving pain killers
by injection, via a tube in your back, or by a machine that you
are able to control yourself by pressing a button (PCA). It is
quite common to experience feelings that you leg is still there (phantom limb
sensations of pain). If it has been possible to use an
epidural for a few days before the operation some of the
sensations and pain can be reduced. If an epidural has not been
used or if there is still pain then this can
be helped with medication and rapidly disappears. You will be visited by the physiotherapist before and
after your operation who will help you with your breathing (to prevent
you developing a chest infection) and with your mobility.
Initially you will be shown exercises in bed. It is very
important that you start to move the stump of you leg after your
operation. If you have had a below the knee amputation then you
must make sure you can straighten you leg and bend the knee
easily. The physiotherapist and nurses will encourage you to transfer from your bed to a chair. As your wound
heals, the physiotherapist will start you walking with help, on
a temporary artificial limb, if it is felt safe for you to
wear one. If not, you will be taught how to use a wheelchair.
Even if you are planning to walk, you may still need a
wheelchair temporarily or for long trips. An appointment will be
made for you to have an artificial limb fitted at the limb
fitting centre at the City Hospital in Nottingham, which, when
you wear clothes, will look like your other leg. |
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6. Going home.
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| Some alterations may be necessary at your home
before you are discharged and in some cases it may be
necessary for you to move into different accommodation.One of
the problems with the NHS at present is the time it takes to get
alterations done at your home. Your home may be visited by a
team from Occupational Therapy who will arrange for any
alterations. You may be taken home by them to see how you cope
but they will not be able to leave you at home until you have
been discharged.
Following discharge, you will need to continue to attend
the physiotherapy department to help you become independent with
your artificial limb or wheelchair. If your stitches need
removing and this has not been done in hospital, the district
nurse will visit you and also check your wound. These days
people walk very well on artificial limbs and you will be
able to walk again provided you have the motivation and fitness
to do so. You will be helped by the physiotherapists,
nurses and doctors at the limb fitting centre. For some
elderly patients it is not possible for them to return to
walking and they may require extra help.
Driving: May be possible with an
amputation, either with an automatic car, or with some special modifications.
Bathing: Once your wound is dry you
may bathe or shower, but you will probably need help at first. You
may also need handles or a hoist to get in and out of the bath
safely.
Sexual activity: You may resume
sexual activity after 2 to 3 weeks if you feel comfortable to do
so.
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7. Complications.
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| Because of the poor blood supply wound healing can
sometimes be slow and very occasionally it is necessary to
perform another amputation higher up the leg if the wound does
not heal. The wound can become infected and if so, will
require treatment with antibiotics. Aches and twinges in the
wound are common and may continue for several months. Chest
infections can occur following this type of surgery,
particularly in smokers, and may require treatment with
antibiotics and physiotherapy. |
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8. What can I do to help myself?
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| If you were previously a smoker you must make a
sincere and determined effort to stop as this may damage
the circulation in your other leg. It is also important that you
do not put on weight as this will make walking with your
artificial leg more difficult. |
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