If you, or someone you love, must undergo amputation due to trauma, you will likely have many questions. The following section will explain what to expect prior to surgery and what will happen during surgery itself.

Prior to Surgery

Before surgery takes place, it will be important to ensure that the patient is in stable condition. If the patient has sustained a major trauma, such as a motor vehicle accident, doctors will want to ensure that no other major injuries are present which may make surgical amputation unsafe for the patient. Besides monitoring of vital signs and the ABC’s (airway, breathing, and circulation), blood will be drawn to assess the status of the patient’s clotting ability, amount of blood loss sustained, the patient’s blood type, and whether the patient has any signs of infection. X-rays of the affected limb may be obtained. In some cases, time permitting, more advanced studies of the affected limb may be done, such as MRI and CT scans. Blood pressure tests, Doppler ultrasound, and angiography may be done if they are deemed necessary and there is sufficient time to assess the circulation in the affected limb. An intravenous (IV) will be inserted to provide necessary fluids and a route for medications, such as antibiotics and pain medications.

The patient’s overall health status will also be taken into consideration. If the patient has an underlying condition, such as diabetes or heart disease, measures will be taken to ensure that these issues are addressed so that the patient has the least risk of complications possible throughout the surgery. 

The Amputation Surgery

The surgeon will choose where to perform the amputation based on several factors. Most importantly, circulation at the level of the incision must be adequate enough to promote healing. The surgeon assesses where to place the incision by:

• checking pulses at a level close to the site
• comparing skin temperatures of the affected limb against those of the healthy limb
• checking that the skin around the proposed incision site has adequate sensation or sensitivity to touch.

The patient will be administered a general or a regional anesthetic. When a severe trauma has occurred, surgeons generally opt for a general anesthetic. A regional anesthetic may be appropriate for more minor amputations. Regardless of the anesthetic used, the patient will be monitored closely during the procedure.

The procedure entails the surgeon shaping muscle and tissue in order to create a stump that will allow for comfortable use of a prosthetic device. The surgeon will also ensure that nerves are well protected, so that stump pain does not become a future problem.

If the amputation is a result of trauma, the surgeon will debride (remove) any crushed bone or injured tissue and will smooth any uneven areas of the bone.

Amputations may be either open or closed. In an open-flap amputation, the skin remains drawn back from the incision site, sometimes for several days. This is so that tissue can be monitored closely. This procedure is done when there is concern about infection. This procedure may be referred to as delayed closure.

In a closed amputation, the skin flaps are sewn shut immediately during the surgery. Surgeons will choose immediate closure if they are fairly certain that the risk of infection is small.

The Post-Operative Period

After surgery, the patient will be moved to the recovery room, where vital signs will be closely monitored. The patient will receive pain medication as needed. Generally, once the patient is awake, and is having no difficulty with breathing on their own, he or she will be moved to a regular room. This generally takes about 2 hours.