In addition to its development due to traumatic events such as accidents, frostbite, injury; Amputation, which is also performed surgically due to diseases, is applied as the last method when there is no other treatment option. The level of amputation, which has two types, closed and open, is determined according to the area where the limb will be amputated.

While the duration of the operation varies according to the amputation level; The pain of the patients usually decreases within 7-10 days, and the surgical wound closes within 3-4 weeks. 2-3 months after the operation, the patient can continue his life with a prosthetic limb. While patients may experience phantom pain, called phantom pain, after surgery, this can be eliminated with medication. However, the possibility of amputation can cause severe psychological reactions in people.

What is an amputation? 

Amputation is the separation of any part of the arm or leg from the body after trauma or surgery.

What are the causes of amputation? 

Amputation can occur due to different reasons. Amputation can develop due to a trauma such as work accidents, traffic accidents and war injuries; It can also be performed as a surgical treatment for any disease such as bone or soft tissue tumor in the arm or leg, infection, blood supply disorder due to vascular disease, excessive tissue damage or dysfunction.

In what situations is amputation performed?

The situations in which amputation is applied are as follows:

– It can be performed for treatment purposes in cancers of the bones and soft tissues in the arm and leg, where the tumor cannot be differentiated from the surrounding normal tissues.

– It can be applied to remove the gangrenous limb after the irreversible deterioration of the blood supply to the hands and feet, which develops due to diseases such as diabetes, smoking and vascular occlusion, and also due to arterial diseases in the arms and legs.

– Amputation can be applied as the last option in the treatment of drug therapy and surgery-resistant bone infections (osteomyelitis), in the form of removal of the inflamed limb.

How is amputation surgery performed?

The amputation procedure is performed in the operating room environment. The type of anesthesia may vary according to the location of the limb to be amputated and according to the patient’s condition. While arm or hand amputations are performed under general anesthesia, some finger amputations can also be performed under local anesthesia. Amputations to be made from the leg or foot area can be performed under general anesthesia or spinal anesthesia (anesthetizing from the waist down). The patient should stop eating and drinking 8 hours before the surgery. Before going down to the operating room, the patient’s limb to be amputated is marked and the level at which this limb will be cut is determined. The limb of the patient who is taken to the operating room is cut from the planned area and the procedure is performed.

Frequently asked questions about amputation 

What are the types of amputation?

Amputation is classified into two types based on the type of wound. The first is open amputation. In open amputation, the wound is followed by open dressing without covering the skin of the amputated limb. This type of amputation is generally applied in amputations due to infections and vascular diseases. However, in cases where the skin tissue in the area to be amputated is not sufficient to close the wound, open amputation treatment may be preferred.

The second type, closed amputation; It is performed when there is enough skin tissue to cover the wound in the amputated area. After the limb is surgically amputated, the tissues and skin in the surgical wound are closed and the amputation process is completed without leaving an open wound.

What are the amputation levels?

Amputation levels are determined according to the level at which the limb will be amputated. In the classification made;

– Although the amputations to be made in the leg area vary according to the location of the disease, they can be done over the knee, below the knee, from the foot level or from the finger level.

– Amputations on the arm can also be performed over the elbow, below the elbow, at the level of the wrist, at the level of the scallops or fingers.

Apart from these, there are also amputations that require the removal of the entire limb from the hip level in the leg or from the shoulder level in the arm.

How is it decided to amputate?

In patients who require amputation due to circulatory disorder, amputation is the only treatment option in cases where the blood circulation of the limb in question is completely lost and blood circulation cannot be restored with necessary interventions and the limb goes into necrosis (death).

In malignant tumors of bone and soft tissues, amputation is the only treatment option in cases where the involvement of the tumor tissue in the vessels, nerves, bones and soft tissues of the arm or leg cannot be replaced by reconstructive surgical methods.

In such cases, the patient is explained in detail that there is no other treatment option other than amputation, and the treatment is decided by obtaining the consent of the patient regarding the necessity of the treatment.

What does traumatic amputation mean?

Traumatic amputation is the amputation that occurs when all or almost all of the limb is severed from any level in the arm or leg after traffic accidents, work accidents or similar injuries. In these amputations, according to the repairability of the tissues (especially the vessels) in the injury area, the amputated limb is sutured back to its place with micro-surgical methods to prevent limb loss.

What is a major amputation?

Major amputation: Amputations made above hand level on the arm and above the heel level on the leg are defined as major amputations.

What is lower limb amputation?

All amputations performed below the hip joint and pelvis (pelvis) are lower limb amputations.

What is a transfemoral amputation?

Transfemoral amputation is an amputation performed by amputating the leg at a level between the knee and hip joint.

What is the stump size?

The part of the limb that remains in the patient after the amputation is called the stump. The length of the stump also varies according to the level of amputation. The stump length gets longer as the amputation level approaches finger level.

How to care for the stump?

If the patient has had an open amputation, the open wound on the stump should be treated with regular dressing. A stump with closed amputation and no open wound does not require specific wound care.

How many hours does amputation surgery take?

The duration of the surgery varies according to the level to be amputated. Generally, as the level goes up, the duration of the surgery may be longer. An amputation made from the level of the finger may take around 30-45 minutes, while amputations from below the knee or above the knee may take 1.5-2 hours, and amputations from the hip or pelvis (pelvis) level may take 2-3 hours.

How should wound healing and care be done after amputation caused by diabetes?

Wound care after amputation is very important because the capillary structures and blood circulation of the tissues are impaired in diabetic patients. With regular wound dressing after the surgery, it should be absolutely sure whether infection or necrosis (tissue death) occurs in the wound. In the event of such a situation, it may sometimes be necessary to amputate again from a higher level.

What awaits the patient after amputation?

Although the reduction of pain due to trauma or surgery after amputation varies from person to person, this period may last for one to two weeks. Apart from this, a condition called phantom pain (phantom pain) can often be seen. In phantom pain, the person feels as if the amputated limb is still in place and may describe a pain different from the normal pain sensation. This is because the nerve connections left in the spinal cord and brain after amputation remember that part of the body can cause a compulsive feeling that it’s still there. This situation can be eliminated with drug therapy. In addition, support can be obtained from psychiatrists and psychologists in order to cope with the psychological depression caused by the loss of a limb.

What should be considered after amputation surgery?

Things to consider after amputation surgery are as follows:

-Regular wound care and dressing after the operation is very important. Trouble-free healing of the stump wound is essential for the use of prosthesis in the future.

-A more functional stump can be obtained after prosthesis insertion by continuing to work the amputated limb with some exercises.

– There is a risk of developing bedsores due to constant lying in patients who have had a very high level of amputation for the leg. In order to avoid these wounds, patients should be allowed to move as much as possible in or out of the bed.

-Patients who lose a foot or leg in the early stages of post-operative recovery are at risk of falling. This risk occurs especially when they try to get out of bed at night. These falls can cause serious damage to the surgical site that requires additional care, perhaps even more surgery. A walker or wheelchair should be placed next to the bed to avoid the risk of falling.

Physical therapy and rehabilitation studies should be started with the completion of the post-operative recovery period.

– Rehabilitation therapy and exercises by looking in the mirror can help the patient adapt to the loss of a limb and avoid falling.

-Smoking should be stopped

A regular exercise program should be maintained and should be worked on to have an ideal body weight.

-Relevant specialists should be consulted for psychological support when necessary.

How many days is the hospital stay after amputation?

If there is no problem in the surgical wound after the amputation surgery, the patient usually stays in the hospital for 2-3 days. This period may be longer after open amputations where open wound dressing may be required, or the patient may be discharged and outpatient outpatient controls can be performed in terms of regular wound follow-up and dressings.

What is the purpose of bandaging after amputation?

It is important that the stump is properly bandaged during and after the dressings in order to fit the shape of the stump on which the prosthesis will be inserted after the amputation, to fit the socket part of the prosthesis properly and to have a smooth shape.

How long does the recovery process take after amputation?

After the amputation procedure, the surgical pain decreases within 7-10 days. While the surgical wound closes within an average of 3-4 weeks, the patient is able to put on the prosthesis and meet his own basic needs within 2-3 months on average.

How long after the foot is cut, is the prosthesis attached?

In the 3rd week after the leg amputation (especially below the knee amputation), the patient can start to use a temporary prosthesis after it is seen that there is no problem in the surgical wound. After making sure that there will be no problem with the surgical wound (after an estimated 2 months), permanent prosthesis can be used.

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