AMPUTATION ABOVE KNEE

MICHAEL EDWARDS

Author's note

This information describes what a patient may expect when having the described operation. The information is specific to the author's practice. Other surgeons will doubtless differ in their preferences. The script can be down loaded and edited to suit other surgeons.

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Your Above Knee Amputation Operation - Some Information

These notes give a guide to your stay in hospital. They also give an idea about what it will be like afterwards. They do not cover everything. If you want to know more, please ask.

What is the problem?

There is not enough blood getting down your leg to keep it alive. The lack of blood causes severe pain and allows serious infection to take hold. The only choice is to take off the damaged part. This must be done high enough to get proper healing of the stump. In your case it means an amputation through the thigh.

What does the operation consist of?

A cut is made so that after removing the diseased part, you end up with a rounded stump made of healthy skin.

Are there any alternatives?

An alternative is to amputate lower down, such as through the knee, or at the mid-shin level. But the lower the level, the higher the risk of poor healing, more operations, and a longer stay in hospital.

A direct operation on the arteries will not help at this stage. Laser treatment and x-ray guided stretching of the arteries will not work for you. Overall, I think your best plan is an above knee amputation.

What happens before the operation?

Welcome to the ward

You will be welcomed to the ward by the nurses or the receptionist. You will have your details checked. You will be shown to your bed and will be asked to change into your nightwear. You will have some basic tests done, such as pulse, temperature, blood pressure and urine examination.

You will be asked to hand in any medicines or drugs you may be taking, so that your drug treatment in hospital will be correct. Please tell the nurses of any allergies to drugs or dressings.

Visits by the surgical team

You will be seen first by the House Surgeon, who will interview and examine you. He, or she, will arrange some special tests such as x-rays and blood samples. The operation will be explained to you. You will be asked to sign your consent for the operation. If you are not clear about any part of the operation, ask for more details from the doctors or from the nurses. They are never too busy to do this.

You will have the operation site marked on you with a skin pencil. You will be seen by the surgeon who will be doing the operation. He will check that all the necessary preparations have been made.

Visits by the anaesthetic team

One or more anaesthetists who will be giving your anaesthetic will interview and examine you. They will be especially interested in chest troubles, dental treatment and any previous anaesthetics you have had, plus any anaesthetic problems in the family.

Visit by the physiotherapist

The physiotherapist will show you how to keep your chest clear after the operation and how to keep moving about. You should not smoke. You will also have exercises to strengthen your arms and shoulders for later on.

Diet

You will have your usual diet until 6-12 hours before the operation when you will be asked to take nothing by mouth. This will let your stomach empty to prevent vomiting during your operation.

The Periods

The periods do not affect the operation.

Shaving

Excess hair will be shaved off to prevent it affecting the wound.

Timing of the operation

The timing of your operation is usually arranged the day before. The nurses will tell you when to expect to go to the operating theatre. Do not be surprised, however, if there are changes to the exact timing.

Premedication

You may be given a sedative injection or tablets about 1 hour before the operation.

Transfer to theatre

You will be taken on a trolley to the operating suite by a ward nurse and a theatre porter. You will be wearing a cotton gown. Wedding rings will be fastened with tape. Removable dentures will be left on the ward. There will be several checks on your details on the way to the anaesthetic room where your anaesthetic will begin.

Usually a general anaesthetic is given so that you are asleep during the operation. Sometimes it is better to numb your legs with an injection in your back and for you to have just a strong sedative. The anaesthetist will talk to you about this.

The operation is then performed.

You will only have the haziest memory of this if at all. You won't have any pain.

What happens after the operation?

Coming round after the anaesthetic

You may spend 24 hours or so on the Intensive Care Ward before coming back to your original ward. Even if you have not had a general anaesthetic you are unlikely to remember anything for several hours due to sedatives. Some people feel a bit sick for up to 24 hours after the operation, but this passes off. You will have some treatment for sickness if necessary.

You may be given oxygen from a face mask for a few hours if you have had chest problems in the past. You will have a plastic tube in your arm to give you a blood transfusion or salt solutions. You will have a fine plastic drainage tube coming out of the skin near the wound, connected to a container. You may have a tube draining urine from the bladder to make your nursing easier.

Warning after a General Anaesthetic

The drugs we give for a general anaesthetic will make you clumsy, slow and forgetful for about 24 hours. This happens even if you feel quite alright.

For 24 hours after your general anaesthetic:

Do not make any important decisions.

Do not use machinery at work or at home. (e.g. do not boil a kettle).

Will it hurt?

There is some discomfort on moving rather than severe pain. You will be given injections or tablets to control this as required. Ask for more if the pain is still unpleasant.

Your original pain will have gone, but you may still feel as if the leg is still there. This is called a 'phantom limb' and is quite normal. The feeling fades in time. By the end of one week the wound should be virtually painfree.

You will be helped out of bed after 24 hours. You should be sitting out of bed comfortably in a week. You should be trying standing and walking with crutches after a week or so.

Warning

Your phantom limb may make you forget you have had an amputation. Always have a nurse to help you out of bed, or you may fall and damage the wound.

Drinking and eating

You will be able to drink within an hour or two of the operation provided you are not feeling sick. The next day you should be able to manage small helpings of normal food.

Opening bowels

It is quite normal for the bowels not to open for a day or so after operation. You will need help with a bed pan at first. Later you will find a commode easy, but you will still need help. If you have not opened your bowels after two days and you feel uncomfortable, ask the nurses for a laxative.

Passing urine

It is important for you to pass urine and empty your bladder after the operation. If you have any difficulty, ask the nurses or doctors.

Sleeping

You will be offered painkillers rather than sleeping pills to help you to sleep. If you cannot sleep despite the painkillers please let the nurses know.

Physiotherapy

The physiotherapist will check that you are clearing your lungs of phlegm by coughing. You can help your circulation by continuous movement of body and limbs. Also you will have exercises to strengthen your thigh muscles and to keep your hip supple. You will continue exercises to build up your arms and shoulders for crutches later.

The wound and stitches

The wound has a single dressing on it. We will look under the dressing after a week to see that the wound is healing. There are no stitches to be taken out. The wound drain is taken out after 48 hours or so.

When you first see the wound, the stump will look very bulgy, but this smoothes off in a week or two. Once the wound has healed you will have stump bandages to shape the stump into a cone to fit the artificial limb.

We will arrange for you to see the limb fitter once the wound is fully healed but you will be having a go at walking with a temporary limb in the Physiotherapy Department before you see the fitter.

Injections

You will have tiny injections into the tummy skin twice a day to keep the circulation going.

Washing

You can wash the wound area as soon as the dressing has been removed. Soap and warm tap water are entirely adequate. Salted water is not necessary. You can shower or take a bath as often as you want.

What about informing my relatives and contacts?

With your permission, The nurses will keep your relatives and contacts up to date with your progress.

How long in hospital?

You should plan to be in hospital for up to 6 weeks to cover any delay in healing of the wound. You may well be out before this. The nurses will talk to you about your home arrangements so that a proper time for you to leave hospital can be arranged.

You will be given an appointment to visit the Surgical Out Patient Department for a check up about one month after you leave hospital. You may need alterations to your home, e.g. bath handles and ramps which will help you when you return. We will arrange these through the Social Work Department. You will need a temporary wheelchair and to learn how to use it.

You may even need to think about a change in your housing if your present home is unsuitable for you after the operation. The social workers will advise you here. You may need convalescence.

Sick notes

Please ask the nurses for sick notes, certificates etc.

After you leave hospital

You are likely to feel tired and need rests 2 or 3 times a day for a month or two after the operation. You will gradually improve.

What about an artifical limb?=

The physiotherapists will train you up towards having an artificial limb. The Limb Fitting Centre will see whether you can manage to use one. It often takes 3 months or more before you have a limb that fits you exactly, since the stump is changing and firming up all the time.

Driving

This depends on how quickly you cope with the artificial limb. You may well be able to drive an automatic car or one specially modified for your needs. We will help you on this.

What about sex?

You can restart sexual relations once the wound has healed.

Work

This depends on how quickly you heal up. It is unlikely that you could do a heavy manual job, but many other jobs are perfectly feasible. We can help here.

Complications

Slow healing is sometimes seen and shows up within the first week or two. The doctors will discuss this with you. Infection sometimes happens. You will be given antibiotics to prevent this. Aches and twinges in the wound may be felt for 6 months or more. They settle down.

General advice

The operation brings a major change to you, but you will end up much better off than before it. Provided you have enough muscle power and good balance, you will have no great difficulty walking on the new limb. The limb fitting process is rather slow and tedious, but will be worth it in the end. If you have any problems or queries, please ask the nurses or doctors.

Any Questions?

If you have any questions, jot them down here and ask the doctors or nurses for answers.

Any complaints?

If you have any complaints, please contact the doctors or nurses straight away. If this does not solve the problem, please write to your surgeon.

Have you any comments?

We welcome your comments and suggestions covering your illness, your treatment in hospital, and your recovery. Please write below any points you would like to make. If you prefer, you need not give your name.

Full name:

Hospital:

Ward:

Date of stay in hospital:

Operation:

Out patients department:

Your admission arrangements:

Your welcome on the ward:

Nursing staff:

General ward atmosphere:

Medical staff:

Ward orderlies:

Portering staff:

X-ray staff:

ECG staff:

Did you know who was who?:

Bedding:

Food and drink:

Privacy:

Locker space:

Toilets:

Bathrooms:

Other patients:

Noise:

Information:

Telephone/TV/radio/newspapers:

Timing of operation:

Preparations for your operation:

Going into the theatre:

In the operating theatre:

In the recovery room:

Coming back from theatre:

Intensive Care ward:

Recovery on the ward:

Pain control:

Sleeping:

Wound dressings:

Stitches, clips:

Progress reports:

Visiting hours:

Rest room:

Tablets, medicines, injections:

Going-home arrangements:

Out-patient follow up:

Anything else?

Continue comments overleaf if you wish.

Please send this questionnaire to your surgeon.