1. Adult Medical-Surgical Nursing
Musculo-skeletal Module: Amputation

2. Amputation: Description
Amputation is removal of a body part usually part or whole of an extremity (limb)

3. Amputation: Causes
Progressive peripheral vascular disease (often a complication of Diabetes Mellitus: “Diabetic foot”)
Trauma: crush injury, burn injury including electrical, frostbite
Chronic osteomyelitis
Gas gangrene
Malignant tumour
Congenital deformity

4. Aim of Amputation
To save life where gangrene (inadequate circulation) infection or malignancy will spread
To preserve as much viable healthy limb as possible
To relieve symptoms
To improve function
To improve quality of life

5. Levels of Amputation
Aim to conserve as much limb as possible and to preserve joints
Surgery at the most distal point of limb which will heal successfully
Depends on:
Circulatory status of extremity
Appropriate level for fitting prosthesis

6. Pre-operative Assessment
Age of patient and general health
Current medications
Psychological impact of proposed surgery
Circulatory status of affected limb:
Doppler flowmetry
Segmental BP
Transcutaneous partial pressure O2 (PaO2)
Related muscle and joint function

7. Amputation: Complications
Haemorrhage
Infection
Skin breakdown/ delayed healing
Phantom limb pain (tingling pain as if limb still present)
Joint contracture
Severe depression and grief over permanent loss of limb, altered body image and modification of lifestyle

8. Amputation: Post-operative Nursing Care
Adequate hydration/ nutritional status
Aseptic technique
Monitor wound healing, presence of oedema/ infection/ skin breakdown
Monitor for onset of complications
Tourniquet available in case of severe haemorrhage
Assess mood

9. Amputation: Care of Limb
Reduce oedema (delays healing):
Elevate limb (avoid placing lower limb on pillow. Risks flexion contracture of hip joint. Rather raise foot of bed)
Constant pressure bandage: (molds stump for prosthesis)
Range of motion exercises/ change of position:
Strengthens and molds muscles of stump
Prevents flexion contracture of joint

10. Amputation: Phantom Pains
Monitor for phantom pains
Address by:
Massage of stump to mold for prosthesis and desensitisation with:
Transcutaneous electrical nerve stimulation (TENS)
Local anaesthetic
β-blocker medication

11. Amputation: Rehabilitation
Multi-disciplinary rehabilitation team (patient, physician, nurse, physiotherapist, psychologist, occupational therapist)
Early application of prosthesis as soon as stump formed
Early usage/ ambulation (↑ muscle tone)
Counselling, encouragement, support for grieving process, lifestyle changes