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  • Print publication year: 2006
  • Online publication date: January 2010

116 - Lower extremity amputations

Summary

Lower extremity amputations are performed for tumors, trauma, peripheral vascular disease, infection, or congenital deformity. The goal of treatment is to return the patient to a functional level allowing pain-free ambulation, which is best achieved through a multi-disciplinary approach involving physician, physical therapist, and prosthetic team. Due to the psychological aspects of care it is important to involve the patient in the decision-making process in order to help the patient understand and concur with the medical staff regarding the importance and necessity of performing the amputation.

The vast majority of amputations are performed for vascular disease and infection resulting from diabetic neuropathy; the most common level is a below knee amputation (BKA). The more proximal the amputation, the greater the metabolic cost of walking. Studies have shown that walking speed is decreased and oxygen consumption is increased with more proximal amputations.

The preoperative consideration of several important factors will directly affect the patient's ability to successfully heal from the amputation. The goal of surgery is to leave enough viable tissue that will heal and allow for fitting with a prosthesis. A serum albumin level below 3.5 g/dl indicates a malnourished patient and an absolute lymphocyte count below 1500/mm3 is a sign of immune deficiency; these values should be corrected prior to any elective amputation case. Some advocate the optimization of serum glucose levels in diabetics, but this is not entirely clear.

Further reading
Bodily, K. C. & Burgess, E. M.Contralateral limb and patient survival after leg amputation. Am. J. Surg. 1983; 146: 280–282.
Chapman, M. W. & Madison, M.Operative Orthopaedics, vol 1. Philadelphia, PA: J. B. Lippincott, 1988: 603–615.
Crenshaw, A. H.Campbell's Operative Orthopaedics. 8th edn., vol 2. St Louis, MO: C. V. Mosby, 1992, 689–710.
Eneroth, M. & Persson, B. M.Risk factors for failed healing in amputation for vascular disease: a prospective, consecutive study of 177 cases. Acta Orthop. Scand. 1993; 62: 369–372.
Evarts, C. M.Surgery of The Musculoskeletal System. 2nd edn., vol 5. New York, NY: Churchill Livingstone, 1990: 5121–5161.
Knetsche, R. P., Leopold, S. S., & Brage, M. E.Inpatient management of lower extremity amputations. Foot Ankle Clin. 2001; 6: 229–241.
Volpicelli, L. J., Chambers, R. B., & Wagner, F. W. Jr. Ambulation levels of bilateral lower extremity amputees: analysis of one hundred and three cases. J. Bone Joint Surg. Am. 1983; 65: 559–605.