To perform an amputation, the physician must remove your diseased limb but preserve as much healthy skin, blood vessel, and nerve tissue as possible.
Choosing the incision site is crucial. If the surgeon removes too little tissue, your wound will not heal because unhealthy tissue remains and the circulation at that level may not be sufficient for healing. To determine how much tissue to remove, the physician will:
- Check for a pulse at a level close to the site prior to the operation.
- Compare the skin temperatures in the diseased limb with those in a healthy limb, and note places where the skin appears red, since an incision made through reddish skin may be less likely to heal.
- Check that your skin around the proposed incision point still has sensitivity to touch.
After the physician makes the initial cut, he or she may decide that more of your limb needs to be removed if the edges of your skin do not bleed enough to allow them to heal.
Before the procedure begins, the anesthesiologist will either put you to sleep with a general anesthetic, or numb your body in the region of the amputation using a regional anesthetic. You will be connected to machines that monitor your heart rate, blood pressure, temperature and brain function. When the anesthetic has taken effect and you are not able to feel any pain, your surgeon will make an incision into your skin, leaving enough healthy skin to cover your stump for better healing.
When the surgeon divides the muscles, he or she may shape them, to make sure that your stump has a comfortable contour for your artificial limb. The surgeon also divides and protects your nerves, so that they are not exposed and painful.
During surgery, clamps are applied to healthy major blood vessels to minimize bleeding. Before finishing your amputation, the surgeon will stitch the vessels, and then release the clamps to ensure that all bleeding points are secure.
If you have a traumatic injury, the surgeon will remove the crushed bone and other tissue, a process called “debridement.” The surgeon then will smooth the uneven areas of your bone to prevent pain once you receive your artificial limb. If necessary, your surgical team may then install temporary drains that will drain blood and other fluids that may accumulate.
When the surgeon has removed the dead tissue, he or she may decide to leave the site open (open flap amputation) or to close the skin flaps (closed amputation). In an open flap amputation, your skin remains drawn back from the amputation site for several days so the surgical care team can clean off of any questionable or infected tissue. Once the stump tissue is clean and free of infection, the skin flaps are sewn together to close the wound in a procedure called “delayed closure.” In a closed amputation, the wound is sewn shut immediately. A closed amputation is usually done if the surgeon is reasonably certain that the chance of infection is small and healing is likely.
The surgical care team may place a stocking over your stump to hold drainage tubes and wound dressings, or your limb may be placed in traction, or a splint, depending upon your particular situation.