Modern Amputation Techniques
The amputation surgery begins after the patient has been given anesthesia. Depending on the type of surgery and the outcome of the planning meeting, the anesthesia is either general or local. General anesthesia means the patient will be unconscious for the surgery, while local anesthesia numbs only the amputation site, and the patient remains awake through the surgery.
During an amputation, the surgeon must cut through several different types of body tissue. In the section below, we'll describe how each tissue structure must be uniquely dealt with during the operation.
Skin: The surgeon begins the surgery by cutting through the skin. The incision is planned so that it will heal quickly and leave an appropriate scar. For example, it's important that the scar doesn't end up in a location where it might rub against the connection socket of a prosthetic limb.
Muscle: Most of the tissue that the surgeon cuts through during an amputation is muscle. Many considerations go into arranging and shaping the remaining muscle tissue, which provides important padding around the bone after the surgery. This padding is vital for maintaining a healthy stump and is equally critical when it comes time to fit the patient with a prosthetic limb.
Nerves: After the nerves are cut, surgeons must take special care in how they deal with the remaining nerve stumps, which can still carry sensory signals - including feelings of pain. To minimize any pain stemming the nerve endings, surgeons cut the nerves higher up than the amputation site, and then sew the nerve endings into the surrounding tissues. This helps control unwanted regeneration of the nerve endings into a disorganized mass called a neuroma, which can be a source of pain to the patient. Surgeons minimize pain by isolating the nerve endings from any areas of motion. This includes keeping the nerve stumps away from large blood vessels, which pulse with
Blood Vessels: Surgeons ligate the cut blood vessels, tying them off firmly to control the blood flow. The surgeons also pay special attention to avoid damaging the blood vessels supplying the remaining healthy tissue. Blood flow is critical for keeping tissue healthy.
Bones: After cutting through the bones, surgeons take care in smoothing any sharp edges, which can cause pain and interfere with the healing process by rubbing on the surrounding tissues. The surgeon also considers issues of bone healing, as well as how the remaining bone will interface with a prosthetic limb.
After properly arranging the remaining muscle around the bone ending, the surgeon closes the skin around the amputation site. Empty space is minimized and tubes are included to drain any fluid that builds up after the operation. Sometimes, when the doctor suspects that factors such as disease might threaten the natural healing process, the skin is closed temporarily. The amputation site is monitored closely for infection over the next several weeks, and if the healing progresses well, the site is closed permanently.
Once a patient undergoes amputation surgery, what is the recovery process like? We'll find out on the next page.