What is an amputation?

Amputation is the technical term for the separation of a body part. This may be planned surgical or traumatic, resulting from an accident. There are many reasons for surgical amputation, but it is usually the last resort and is not performed lightly. The decision to amputate a body part is usually made when tissue is so damaged that it dies, increasing the risk of life-threatening infections. This occurs, for example, in vascular diseases, bacterial infections, advanced diabetes mellitus, cancer or after serious accidents. In principle, the aim is to amputate as little as possible and to preserve the function of the affected body part as far as possible.

Transtibial amputation and prosthesis

How does a transtibial amputation work?

A common reason for a lower leg amputation is vascular disease such as peripheral arterial disease (pAVD), also known as smoker's leg or shop window disease. Often, if pAVD is present, several toe or forefoot amputations precede the decision to remove the entire lower leg. Other reasons include serious accidents or circulatory or wound healing disorders in diabetes mellitus.

In a below-knee amputation, the leg is surgically severed below the knee. By preserving the knee joint, the ability to bend is largely retained. The exact amputation height is decided individually, depending on the condition of the vessels or tissue. During the amputation, care is taken to carefully suture the large vessels and leave enough soft tissue and skin to create a weight-bearing residual limb to which a prosthesis can be fitted.

How is a prosthesis fitted?

An amputation is a drastic event for those affected. The sudden loss of a body part presents patients with numerous new challenges. A prosthesis makes it possible to regain mobility and thus a piece of quality of life after a transtibial amputation. Different prostheses can be used depending on the amputation level and basic requirements. We take sufficient time for consultations in order to find an individually suitable solution for each patient. Before the prosthesis is built and fitted, it is important that the residual limb has healed to avoid possible complications. In some cases, a so-called transitional prosthesis can be used. Transitional crutches or wheelchairs can be used to ensure the highest possible mobility until the fitting of a definitive prosthesis.

Transtibial amputation and prosthesis

What material is a prosthesis made of?

A prosthesis usually consists of many different materials. The socket, where the amputation stump is held, is usually made of carbon, which is kept in shape with a special resin. The cosmetic, if desired, is made of a soft and durable foam, which is ground into shape by our technicians. However, other materials such as wood, metal or other foams can also be used.

What complications can occur after an amputation?

In addition to general surgical risks such as wound healing disorders, bleeding and infections, so-called phantom sensations can occur after amputations. These are sensations such as burning, cold or warm sensations and even stabbing pain in the area of the amputated limb. This phenomenon can be prevented by early local anesthesia, for example, during a toe amputation. In treatment, mirror therapy, transcutaneous nerve stimulation, drug therapy and biofeedback have proven to be particularly effective.

[1] Griffin, K.J., Rashid, T.S., Bailey, M.A., Bird, S.A., Bridge, K., Scott, J.D.A., 2012. toe amputation: a predictor of future limb loss? J Diabetes Complications 26, 251-254. https://doi.org/10.1016/j.jdiacomp.2012.03.003

[2] Isaacs-Itua, A., Sedki, I., 2018. management of lower limb amputations. Br J Hosp Med (Lond) 79, 205-210. https://doi.org/10.12968/hmed.2018.79.4.205

[3] Kaur, A., Guan, Y., 2018. phantom limb pain: A literature review. Chin J Traumatol 21, 366-368. https://doi.org/10.1016/j.cjtee.2018.04.006

[4] Roll, C., Forray, M., Kinner, B., 2016. amputation and disarticulation of the lesser toes. Oper Orthop Traumatol 28, 345-351. https://doi.org/10.1007/s00064-016-0451-y

[5] Anvil - pain therapy

https://next.amboss.com/de/article/xN0EWg#Zd9b5808a36be5c17e92b209045003b83 (aufgerufen am 30.07.2022)

[6] Anvil - Operative procedures in trauma surgery/orthopedics

https://next.amboss.com/de/article/vl0AAT?q=amputation#Zc1f40bd23bcce41c743d098eaa88dfea (accessed 07/30/2022)

[7] Anvil - Perioperative management

https://next.amboss.com/de/article/550ikg (accessed 07/30/2022)

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