Date issued: September 2021
Review date: September 2023
This booklet aims to give you information about your amputation and prepare you for what you can expect to happen following your surgery.
This booklet contains information about:
Why is amputation needed? 3
What level of amputation will I need? 3 - 4
What if I don’t want the operation? 4
What are the risks of amputation? 4
Who will be involved in my care? 4
What to expect after my amputation? 7
Pain Control/Phantom Limb Sensation 7 - 8
Looking after your Limb/Residual Limb Handling 8
Physiotherapy and Occupational Therapy 10
Artificial Limb (Prosthesis) Provision 11
Looking after yourself 13
Useful Contacts 16 - 18
If you have any further questions that are not covered in this guide, please write them down and ask a member of the ward team or Thornberry Centre.
Why is Amputation needed?
Your consultant or a member of the team will have discussed with you and your family the reasons for the amputation and consent would have been obtained prior to your operations (unless it was an emergency).
There are several reasons why an amputation is required.
• It may be due to disease of the blood vessels where the arteries become narrowed/blocked, thus limiting the blood supply to the legs and feet
• It may be due to circulatory problems or severe infection due to complications of diabetes
• It may be as a result of an accident or injury if there has been extensive damage to your limb that cannot be repaired
• It may be due to a cancerous tumour
• It may be due to non-healing of fractures
In many cases prior to amputation, the affected limb may have caused serious infections and severe pain and may have been a threat to life.
What level of amputation will I need?
Your consultant will discuss this with you. The most common levels of amputation are below the knee, through the knee or above the knee.
It is important that your wound heals well to give you the best outcome after surgery, therefore the level of amputation may depend on your circulation/blood supply.
If there are significant issues with your wound healing or extensive infection, it may be possible that you would require a further operation to revise the amputation to a higher level.
What if I don’t want the operation?
If you do not consent to the operation, we will respect your decision, however it is important you know that your symptoms may worsen over time. If your leg significantly deteriorates you may become severely/dangerously ill due to toxins being released into your body from the dead tissue.
If you choose not to have the operation and subsequently change your mind, speak to your consultant or GP as soon as possible.
What are the risks of amputation?
Whilst all operations carry some risk, your individual circumstances will need to be considered before any operation. An anaesthetist will assess your fitness for surgery and your medical team will discuss these risks with you.
Who will be involved in my care?
There are many professionals who work together to provide the care and support you need during your hospital stay and following discharge. You can expect to see many people during your stay at Derriford Hospital. They will be involved with your care and aim to support you.
Doctors: You will be under the care of a consultant surgeon who will have a team of doctors helping them. They will monitor your recovery and manage any medical issues you may have. On discharge from hospital, you are likely to see your consultant as an outpatient who will then hand over your day-to-day care to your GP.
Nurses: Whilst on the ward you will have a designated nurse each day who will look after your everyday needs on the ward such as pain relief, changing dressings, your personal care and comfort.
The Acute Care Team: A specialist team of healthcare professionals who will review you, if you have an epidural or nerve block/infusion to ensure your pain is well controlled.
Physiotherapist: You will work with your physiotherapist (physio) who will help you to improve your physical ability following your amputation. They will see you regularly after your operation until the time of your discharge. Together you will set realistic goals for mobility and work towards these on the ward or in the gym. You will also be given exercises to do independently to maximise your recovery/rehabilitation.
Occupational Therapist: Your Occupational Therapist (O.T) concentrates on maximising your safety and independence both on the ward and when you go home. They will ensure you can independently complete everyday activities (ADL) and may take you on a home visit before you are discharged. An assessment can be completed for carers to assist you with some activities when you return home, if required. This visit may not be necessary, if you are being transferred to another rehabilitation setting/ hospital.
Discharge Case Manager/Social Worker: You may be seen by these members of the team to help plan your discharge (if required). If you have any concerns regarding being discharged home/coping at home following your operation, please let the ward staff know as soon as possible.
Thornberry Centre: The team at the Thornberry Centre consists of a Rehabilitation Consultant, Prosthetics Specialist Nurse, Prosthetics Specialist Physiotherapist, Prosthetists and Rehabilitation Assistants. The team at the Thornberry Centre will consider if a prosthesis is appropriate for you. If it is decided that you will have a prosthesis, they will measure for and provide you with your prosthesis and will provide on-going rehabilitation and assessment as required. They are based in Plymouth but have a satellite clinic at Cambourne and Redruth Hospital.
What to expect after my operation
When you have returned from theatre your residual limb will have a dressing and/or bandages covering it. You may have a drain to remove excess fluid and blood from the wound, which will be removed after 1-2 days. You may also have an epidural in your lower back, a nerve block for pain relief or a pain relief button. If for some reason the pain relief is not effective, please let the nursing staff know.
Initially, following surgery, you may well feel a sense of relief; this is very common if you have been experiencing a lot of pain. You may feel sad, angry, frustrated and at times depressed. However, all these feelings are normal, and it is important to talk them through with the team and your family. You may be referred to a psychologist who can help you with these feelings, this service will be discussed with you if you require it, please ask your nurse, doctor or therapist.
It is normal to experience some pain or discomfort around the wound site in the early days after surgery. This should improve as healing progresses. It is important that you let the ward staff know if you are in pain, or after discharge from hospital let your GP know if you are in pain. Good pain control will help you move forwards in your rehabilitation journey.
Phantom limb sensation/pain
The vast majority of people who have had an amputation will experience the feeling that their leg is still present after the operation. This is a perfectly normal reaction and is caused by the cut nerves still sending messages to the brain. Though it may feel strange and unpleasant, it will not necessarily be painful and will decrease or disappear over time. If this causes you a lot of discomfort, then please let the nursing/therapy staff know who will arrange further reviews from the medical team.
Looking after your residual limb (amputated limb)
To aid the healing of your residual limb you should:
- Perform your exercises as advised by the Physiotherapy team.
- Have regular periods of lying flat on your bed during the day if possible
- Maintain good residual limb hygiene
- Eat a good diet i.e., adequate protein and plenty of fresh fruit and vegetables
- Think ahead and plan movements to avoid potential hazards in order to prevent falls or knocking/jarring your residual limb, the Physio team will assess and discuss the best method for you to transfer safely.
Residual Limb Handling
You will be encouraged to explore and handle your residual limb. This helps to re-educate sensation and thereby reduce phantom limb sensation. It also helps you to accept and come to terms with your amputation and move forward.
- Ensure your bottom is at the back of the wheelchair.
- Sit upright.
- Shift your body weight to alleviate pressure as able.
- If you feel uncomfortable in your wheelchair/bed please inform a member of staff.
- If you have a below-knee amputation it is important that you use your stump board. Elevating your leg on the stump board aids wound healing and prevents contractures (shortening of the soft tissues behind your knee).
- Do not bend your knee for long periods of time or place a pillow under your knee/residual limb as this can also lead to shortening of the soft tissues behind your knee or at your hip. If this happens, it may affect progress when it comes to your prosthesis.
Physiotherapy and Occupational Therapy
You will receive Physiotherapy and Occupational Therapy throughout your stay in hospital.
Early post-operative mobilisation prevents potential complications and for this reason patients are encouraged to mobilise out of bed as soon as possible following amputation.
If you are feeling well, your Physiotherapist and Occupational Therapist will visit you as soon as possible post operatively and assist you to transfer from your bed to a wheelchair. You will be helped to learn how to use your wheelchair safely by the therapy staff.
Once you are free from medical attachments the therapy staff will work with you on the ward or in the gym to strengthen your upper limbs and lower limbs, maintain joint range of movement, re-educate your balance and help optimise your independence, for example transferring on/off bed, chair, toilet, washing and dressing, using your wheelchair and managing kitchen activities. You will be given exercises to do independently to aid your rehabilitation.
You will be restricted to using a wheelchair initially after your amputation, as “Hopping” with a walking aid is not recommended following lower limb amputation due to the high risk of falling and damage to your residual limb.
A wheelchair will be loaned to you during your stay at Derriford Hospital. This is provided as soon as possible following your operation; it is possible that this chair will be changed during your admission. A wheelchair from AJM Healthcare will be ordered for you, they will supply your permanent chair following an assessment. If you live out of the Plymouth area, you will be referred to your local Wheelchair service.
Home visits, it may be appropriate for the O.T. to arrange a visit to your home. This is to assess your ability to access the property and your ability to function. People often encounter difficulties in the home environment. The O.T will be able to recommend different ways to undertake tasks and to provide equipment if necessary.
It is sometimes necessary to attend a local hospital closer to home to continue your rehabilitation prior to your discharge home. If your home is suitable and you are able to go home, a referral will be made to your local Community Therapy team who will continue your rehabilitation on returning home.
In some cases, it is necessary to be discharged to a temporary placement. If this is the case, the multi-disciplinary team will discuss this with you.
Artificial Limbs (Prosthesis)
Not everyone who has an amputation will be able to use an artificial limb/prosthesis. Some of these factors include the level of your amputation, the condition of your remaining limb, your ability to walk before the amputation and any other medical conditions you may have e.g., heart failure, COPD, Diabetes.
You should not compare yourself to anyone else, everyone is individual and will be treated as such.
The ward staff will refer everyone for consideration of a prosthesis/artificial limb at the Thornberry Centre.
You may choose to consider a prosthesis at a later date once you feel you have recovered from the operation and fully regained your strength. If you are unsure, it is important to attend your appointment at the Thornberry Centre/limb fitting centre to discuss this. The Thornberry Centre provides ongoing assessment for your needs post-amputation.
Process for getting an artificial limb
If you are suitable for a prosthesis (artificial limb) the process is as follows:
• A referral to the Thornberry Centre will have been completed by the ward therapy staff after your surgery.
• You will be invited for an assessment with the team at the Thornberry Centre to discuss if an artificial limb is appropriate for you (usually 6-8 weeks after your operation).
• If you are suitable for an artificial limb, you will be measured for a stump shrinker (a tight sock to reduce swelling and aid shaping of the residual limb) once your wound has healed. This will be provided by the Thornberry Centre.
• A Prosthetist at the Thornberry Centre will then take measurements or a cast of your residual limb. This is usually around 8 weeks after your operation (depending on wound healing).
• The measurements or cast are used to make your artificial limb, this takes approx 2 -3 weeks.
• A Prosthetist will fit your artificial limb at the Thornberry Centre.
• You will then undertake Physiotherapy sessions to teach you how to put it on/off, mobilise and work towards your goals. This may be at the Thornberry Centre or under the care of your local physiotherapy team.
Looking after yourself
Avoiding injury after amputation is important. Falls are common following amputation as it is harder to keep your balance. There are some things you can do to reduce your risk of falling:
Keep frequently used items within easy reach.
When moving in and out of your wheelchair make sure you use your brakes and that you are positioned close enough to manage the transfer easily. Take your time, rushing is more likely to cause a fall.
Make sure your home environment is clear and clutter free. Lifting up loose fitting rugs, clearing away loose cables and ensuring good lighting can reduce your risk of falling.
Wear comfortable well-fitting shoes with a non-slip sole.
Make sure your eyes are regularly tested and you wear your glasses if prescribed.
Ensure regular check-ups with your GP to review your medication and blood pressure.
Be especially careful when your first wake up or move from bed at night, if you have phantom limb sensation it can be easy to forget that you have your leg amputated and can cause people to fall.
It is widely accepted that there are certain factors which contribute to blocked arteries e.g., a high cholesterol diet, smoking, lack of exercise, obesity, excessive stress and lack of control over other diseases such as diabetes or hypertension.
In order to prevent or slow down the progression of arterial disease these factors should be eliminated.
It is recommended that you
1) STOP SMOKING if you require help to do this, please ask a member of staff as there are services available to support you.
2) Eat a low cholesterol diet
- Cut down on animal fat in your diet; change from red meat to chicken or fish, if possible.
- Eat more fruit and vegetables.
- Eat less salt, less sugar, drink less alcohol
- Drink low fat milk
3) Where possible keep active; persevere with using your artificial limb. Walking is excellent exercise.
4) Reduce stress if you feel this is a problem. Your team can offer you support about this.
The Thornberry Centre (Disablement Services Centre)
1 Brest Way
Derriford Business Park
Tel: 01752 434200
Disability Information Advice Centre (DIAC)
Ernest English House
Tel: 01752 201065
The Limbless Association
Waterhouse Business Centre
2 Cromar Way
Tel: 0800 644 0185
(Soldiers, Sailors & Airmans Families Association)
SSAFA Office, Fenner Building, HM
Tel: 01752 553 414
Citizens Advice Bureau
32 Mayflower St
Tel: 0300 330 9043
LimbPower (National Disability Sports Organistion)
Tel: 07502276858 General enquiries
Tel: 07503030702 Sports enquiries
Tel: 0870 240 0009
Motoring after an amputation | RiDC (rica.org.uk)
Tel: 020 7427 2463
Public Information Leaflet and Poster for amputees - BACPAR