Definition: Surgical removal of a toe, foot, or part of a foot
Parts of the Body Involved
* Toe
* Foot
Reasons for Procedure
Amputation is done to treat either gangrene or persistent pain. These conditions are most often caused by poor circulation, most often linked to:
* Complications of diabetes (most common reason)
* Bone infection ( osteomyelitis)
* Trauma (crush injury)
* Cancer
* Severe frostbite
* Buerger's disease
* Severe atherosclerosis
* Blood clots
* Vasospastic disorders such as lupus and scleroderma
Risk Factors for Complications During the Procedure
* Infection
* Poorly controlled diabetes
* Poor blood circulation
* Bleeding disorders
* Congestive heart failure
* High blood pressure
* Kidney failure
What to Expect Prior to Procedure
Your doctor will likely do at least some of the following:
* Blood tests
* X-ray of toe and foot
* Bone scan to see if the bone is infected
* A prolonged period of debridement, antibiotics, and wound care in an attempt to heal wounds medically
* Possible angioplasty or bypass procedures to improve the circulation
* Tests to evaluate blood circulation and help the surgeon determine how much of the foot or toe needs to be amputated:
o Xenon 133 studies
o Oxygen tension measurement
o Doppler measurement
o Skin fluorescent studies
o Skin perfusion measurements
o Infrared evaluation of skin temperature
o Angiogram
o Magnetic resonance angiography (MRA)
In the days leading up to your surgery:
* Arrange for a ride to and from the procedure
* Arrange for help at home after the surgery
* The night before, eat a light meal and do not eat or drink anything after midnight
* You may be asked to shower the morning of your procedure with a special antibacterial soap
<>bAnesthesia
General, local, or spinal
Description of the Procedure
You will be given IV fluids and antibiotics. Your foot is washed with an antibacterial solution. The surgeon makes an incision into the skin, around the area to be removed. Blood vessels are tied off or cauterized (burned) to prevent bleeding.
After the foot or toe is removed, the ends of the bone(s) are smoothed with a special surgical rasp. The remaining skin and muscle flap are pulled over the open area and closed with stitches. A sterile dressing is placed over the incision.
If there is an active infection, tubes may be left in place to allow fluids to drain. The skin is not closed if there is an active infection. Instead, the area will be packed with a moist dressing, which is changed daily.
* Pain medications
* Possibly antibiotics
* Foot should be kept elevated
* The toe or foot is wrapped with a bulky dressing to protect it from trauma
How Long Will It Take?
20-60 minutes
Will It Hurt?
Anesthesia prevents pain during surgery.
Possible Complications
* Difficulty healing
* Collection of blood (hematoma)
* Infection
* Phantom limb pain (a painful sensation that the foot or toe is still there)
* Stump pain (severe pain in the remaining tissue)
* Continued spread of gangrene, requiring amputation of more areas of your foot, toes, or leg
* Depending on which toe has been removed, you may walk with a limp
Average Hospital Stay
2-7 days
Postoperative Care
* You'll be encouraged to get up and begin walking as soon as the wound allows.
* You may need to wear a cast, a special postoperative shoe, or a regular shoe with the foot box removed until the stitches are taken out.
* Stitches will be removed in about three weeks.
* You may be advised to begin an exercise, physical therapy, or rehabilitation program.
* You may need to be fitted with a prosthetic foot. Physical therapy will help you learn how to walk on it.
* If you have diabetes, to reduce your risk for future problems:
o Ask your doctor about appropriate foot care
o Work to tightly control your blood sugar
* If you are a smoker, you should quit.
* You may need to take a blood thinner, such as aspirin.
Outcome
Hopefully, the amputation will stop the spread of gangrene and will allow the remaining toes, foot, and leg to stay healthy.
Call Your Doctor If Any of the Following Occurs
* Signs of infection, including fever and chills
* Redness, warmth, swelling, increasing pain, excessive bleeding, or discharge at the incision site
* Chalky white or blackish appearance of foot, other toes, or leg
* Decreased sensation, numbness, or tingling in the rest of your foot, toes, or leg
* Cough, shortness of breath, chest pain, or severe nausea or vomiting
Parts of the Body Involved
* Toe
* Foot
Reasons for Procedure
Amputation is done to treat either gangrene or persistent pain. These conditions are most often caused by poor circulation, most often linked to:
* Complications of diabetes (most common reason)
* Bone infection ( osteomyelitis)
* Trauma (crush injury)
* Cancer
* Severe frostbite
* Buerger's disease
* Severe atherosclerosis
* Blood clots
* Vasospastic disorders such as lupus and scleroderma
Risk Factors for Complications During the Procedure
* Infection
* Poorly controlled diabetes
* Poor blood circulation
* Bleeding disorders
* Congestive heart failure
* High blood pressure
* Kidney failure
What to Expect Prior to Procedure
Your doctor will likely do at least some of the following:
* Blood tests
* X-ray of toe and foot
* Bone scan to see if the bone is infected
* A prolonged period of debridement, antibiotics, and wound care in an attempt to heal wounds medically
* Possible angioplasty or bypass procedures to improve the circulation
* Tests to evaluate blood circulation and help the surgeon determine how much of the foot or toe needs to be amputated:
o Xenon 133 studies
o Oxygen tension measurement
o Doppler measurement
o Skin fluorescent studies
o Skin perfusion measurements
o Infrared evaluation of skin temperature
o Angiogram
o Magnetic resonance angiography (MRA)
In the days leading up to your surgery:
* Arrange for a ride to and from the procedure
* Arrange for help at home after the surgery
* The night before, eat a light meal and do not eat or drink anything after midnight
* You may be asked to shower the morning of your procedure with a special antibacterial soap
<>bAnesthesia
General, local, or spinal
Description of the Procedure
You will be given IV fluids and antibiotics. Your foot is washed with an antibacterial solution. The surgeon makes an incision into the skin, around the area to be removed. Blood vessels are tied off or cauterized (burned) to prevent bleeding.
After the foot or toe is removed, the ends of the bone(s) are smoothed with a special surgical rasp. The remaining skin and muscle flap are pulled over the open area and closed with stitches. A sterile dressing is placed over the incision.
If there is an active infection, tubes may be left in place to allow fluids to drain. The skin is not closed if there is an active infection. Instead, the area will be packed with a moist dressing, which is changed daily.
* Pain medications
* Possibly antibiotics
* Foot should be kept elevated
* The toe or foot is wrapped with a bulky dressing to protect it from trauma
How Long Will It Take?
20-60 minutes
Will It Hurt?
Anesthesia prevents pain during surgery.
Possible Complications
* Difficulty healing
* Collection of blood (hematoma)
* Infection
* Phantom limb pain (a painful sensation that the foot or toe is still there)
* Stump pain (severe pain in the remaining tissue)
* Continued spread of gangrene, requiring amputation of more areas of your foot, toes, or leg
* Depending on which toe has been removed, you may walk with a limp
Average Hospital Stay
2-7 days
Postoperative Care
* You'll be encouraged to get up and begin walking as soon as the wound allows.
* You may need to wear a cast, a special postoperative shoe, or a regular shoe with the foot box removed until the stitches are taken out.
* Stitches will be removed in about three weeks.
* You may be advised to begin an exercise, physical therapy, or rehabilitation program.
* You may need to be fitted with a prosthetic foot. Physical therapy will help you learn how to walk on it.
* If you have diabetes, to reduce your risk for future problems:
o Ask your doctor about appropriate foot care
o Work to tightly control your blood sugar
* If you are a smoker, you should quit.
* You may need to take a blood thinner, such as aspirin.
Outcome
Hopefully, the amputation will stop the spread of gangrene and will allow the remaining toes, foot, and leg to stay healthy.
Call Your Doctor If Any of the Following Occurs
* Signs of infection, including fever and chills
* Redness, warmth, swelling, increasing pain, excessive bleeding, or discharge at the incision site
* Chalky white or blackish appearance of foot, other toes, or leg
* Decreased sensation, numbness, or tingling in the rest of your foot, toes, or leg
* Cough, shortness of breath, chest pain, or severe nausea or vomiting
