Amputation is the removal of a limb by trauma, medical illness, or surgery. There are several types of amputations including partial foot amputation, ankle disarticulation, and trans-femoral amputation. An amputation surgery team works to remove the diseased body part and shape the remaining stump. After amputation, healing and wound care involves keeping the stump clean, dry and bandaged until stitches are removed. Phantom limb sensations and pain are common after amputation as nerve connections remember the missing limb. Physiotherapy and rehabilitation help the patient regain mobility and independence.

1. Amputation
generic bsn 2nd year , 4th semester
adult healthnursing - II
Ms. Sumitagill
Ion, jsmu
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2. Definition
• Amputation is the removal of
a limb by trauma, medical illness, or surgery. As
a surgical measure, it is used to control pain or a
disease process in the affected limb, such
as malignancy or gangrene.
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3. Types of amputation
• Partial foot Amputation:
• Ankle Disarticulation: at the ankle joint.
• Trans-tibial Amputation: Amputation of the lower
limb between the knee joint and the ankle joint.
• Knee Disarticulation: Amputation of the lower limb at
the knee joint
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4. Types of amputation
• Trans-femoral amputation of the lower limb between
the hip joint and the knee joint, commonly referred to an
above knee amputation.
• Hip disarticulation amputation of the lower limb at the hip
joint
• Trans-pelvic disarticulation amputation of the whole
lower limb together with all or part of the pelvis.
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5. Double Amputation
• Double amputation is removal of both hands,
feet, arms or legs.
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6. Amputation Surgery Team
• Orthopaedic and orthopaedic oncologic surgeons
work with a plastic and reconstructive surgeon,
along with a range of nurses and surgical
technologists, to perform a surgical amputation
procedure.
• Together, they remove the diseased or damaged
body part, and then work with the remaining bone
and soft tissue to shape the stump.
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7. Healing and Wound Care After
Amputation
• Whether or not you plan to use a prosthetic, the
healing process and a
customized rehabilitation plan can provide you
with the best chance to resume your life
activities.
• The post-amputation stump must be kept
bandaged, clean and dry until the stitches
(sutures) can be removed.
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9. Healing and Wound Care After
Amputation
• When the initial bandaging comes off, the doctor
may offer a compression device called a shrinker
sock to prevent swelling in the stump as the
blood vessels heal.
• This process helps prepare the stump for a
prosthesis .
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11. Phantom Pain
• Phantom limb sensations and phantom pain are
almost universal in people who undergo an
amputation.
• The remaining nerve connections in the spinal
cord and brain “remember” the body part, and
can cause a compelling sensation that it is still
there (phantom limb syndrome) .
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12. Phantom Limb
• The surgeon can take steps during the amputation
surgery to address the nerves that carry sensations
back to the brain that affect pain and phantom
sensations. The nerve procedures may also be
performed later for patients who have already had
an amputation and are still experiencing severe
nerve pain.
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13. Pain Control After Amputation
• Uncontrolled pain can be a complication of any
surgery, and the amputation team works hard to
make sure pain is manageable.
• A peripheral nerve block might be necessary to
control pain and phantom limb sensations.
• Lidocaine, bupivacaine
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14. Complications Post Amputation
• Oedema : After the amputation, there is an imbalance between fluid
transfer across the capillary membranes and lymphatic
reabsorption . This, in combination with reduced muscle tone and
inactivity, can lead to stump oedema.
• Wounds and infection: Surgical site infection after amputation is
common and as well as increasing patient morbidity, can have
negative effects on healing, phantom pain and time to prosthetic
fitting . Risk factors for a stump infection include diabetes mellitus.
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15. Types of Wounds May Be
Encountered
• Tissue Necrosis: Poor tissue perfusion leads to
ischaemia and necrosis. Dusky skin changes,
mottled discolouration and slough can be
observed.
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16. Types of Wounds May Be
Encountered
• Skin Blister: Wound oedema, reduced elasticity or
tight stump dressings, and adhesive dressings
applied with tension can all increase the friction of
the epidermis and cause blistering of the skin.
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17. Prosthetic pain is also a concern and
may be caused by
• Ill-fitting socket , too tight, too loose, causing
friction/blisters
• Incorrect alignment and pressure distribution
• Excessive sweating/skin breakdown
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19. Physiotherapy Regimes Should
Consist of The Following Elements
• Range of movement exercises
• Strengthening exercises
• Stretches
• Early mobility practice
• Transfer practice
• Balance exercises
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22. References
• Low EE, Inkellis E, Morshed S. Complications and revision amputation following trauma-
related lower limb loss. Injury. 2017 Feb 1;48(2):364-70. (abstract)
• Elizabeth Bouch, Katie Burns, Elizabeth Geer, Matthew Fuller and Anna Rose. Guidance
for the multi disciplinary team on the management of postoperative residuum oedema
in lower limb amputees. BACPAR
• Airaksinen, O., Kolari, P.J., Herve, R. and Holopainen, R. (1988) Treatment of post-
traumatic oedema in lower legs using intermittent pneumatic compression.
Scandinavian Journal of Rehabilitation Medicine, 20(1), pp.25-28
• Engstrom, B and Van de Ven, C (1999). Therapy for Amputees. Churchill Livingstone.
• Bouch E, Burns K, Geer E, Fuller M, Rose A. Guidance for the mulfi-disciplinary team on
the management of post-operafive residuum oedema in lower limb amputees. BACPAR
post operative oedema guidance (2012) [Accessed 10 Oct 2017]
• Coulston, J E, Tuff V, Twine C P, Chester J F, Eyers P S and Stewart A H R (2012) Surgical
Factors in the Prevention of Infection Following Major Lower Limb Amputation.
European Journal of Vascular and Endovascular Surgery, 43 (5), pp.556-560
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