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Why do I need this operation?

1. If you have an infected wound in the foot the tissue may need to be removed to prevent the spread of the infection to surrounding tissues and your foot bones. This will help to restore your wound tissue to a healthy level so that it can heal.

1. If the tissue has become necrotic (dead) due to a lack of or poor blood supply and there is no option to repair or remove the tissue, the toe or toes may need to be removed in combination with restoring the blood flow to your foot.

Why has this happened?

There are many risk factors that can increase the chance of needing debridement or amputation however the most common causes are:

Diabetes: Due to increased sugar levels in the blood/tissues which slows wound healing and makes tissue more prone to damage.

Arterial Disease: A reduced blood flow to the foot caused by a narrowing or blockage in the arteries of the leg which starves the tissue of oxygen and nutrients.

What happens after the operation?

After the operation you will come back to the ward after spending some time In recovery. You may have a drip in your vein for fluids until you feel able to eat and drink. The nurses on the ward will give you pain relief if needed and monitor you post operatively. You will also be given antibiotics through your vein to help treat the underlying infection.

You may be fitted with a special dressing called a topical negative pressure (TNP) pump. To help your wound to heal. This will be changed every 3 days. It will require you to carry a special pump system in a bag with you. This is an effective therapy to speed up the wound healing process. The progress of your wound will be monitored at each dressing change.

You are usually able to mobilise when you feel well enough with assistance. This is most commonly the next day. The physiotherapist will help you with this.

You will be given a special shoe to offload the area of your foot that has been operated on to allow the wound to heal. If you need long term adaptation to your footwear you can be referred to an orthotist for assessment of shoes/inserts to be made to fit your feet. This is likely to be done as an outpatient.

Complications

Phantom limb pain (common) You may experience feeling that the amputated toe is still there. This is due to disruption to the nerves during surgery and usually settles.

Bleeding (Common) A small amount of bleeding is expected post operatively. This will usually occur early on return from theatre and can be treated with elevation.

Swelling (Common) Some swelling may occur to the surrounding skin due to trauma to the tissues. This will usually resolve over time and with elevation.

Wound infection (uncommon) It is possible to develop further infection after an operation. If this happens is may require antibiotics or further debridement or cleaning in theatre.

Further amputation (uncommon) If the wound continues to deteriorate or does not respond to the removal of tissue it may need another operation to amputate more of the area.

Going Home

You will need continuing wound care dressings.

Your dressing with either be changed at your GP practice or by the district nurses if you have a topical negative pressure dressing or you are housebound.

Driving: You can usually drive when you can safely perform an emergency stop without this causing pain. Please contact your insurance company.

Bathing: When your wound is dry and healed you can bathe and shower as normal.

Work: You will usually need to stay off work until the wound is healed if your job involves long periods of time on your feet to allow the wound to heal. It is recommended 6 weeks or until the wound has healed.

Exercise: You are able to mobilise but must wear the specialist footwear that has been provided. If you have a TNP dressing it is not recommended to walk for long periods. Aim for 10-15 min sessions regularly. Do not sit for long periods.

Elevate your leg at rest to prevent swelling when sitting.

Who to contact If I have any concerns?

Less than 24 hours post discharge:

Call 01752 202082 and ask for the ward you were discharged from.

After 24 hours post discharge

Urgent Medical Help: 111 or 999 or if out of hours

Pain/ medication concerns: GP

Operation specific questions: Consultant’s Secretary or Vascular Specialist Nurse

Consultant Vascular Surgeon and Lead Clinician

Mr Devender Mittapalli

Secretary: 01752 431822

Consultant Vascular and Transplant Surgeon

Mr Jamie Barwell

Secretary: 01752 431822

Consultant Vascular Surgeon

Surgeon Commander Cris Parry RN

Secretary: 01752 431822

Consultant Vascular Surgeon

Miss Catherine Western

Secretary: 01752 431805

Consultant Vascular Surgeon

Lt Col Robert Faulconer

Secretary: 01752 431805

Consultant Vascular Surgeon

Mr Hashem Barakat

Secretary: 01752 431822

Vascular Nurse Specialist

Mr Alan Elstone

Miss Jess Webster

01752 43180