AMPUTATION TOE
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.
You will need Abobe Acrobat Reader which can be downloaded from http://www.adobe.com/uk/products/acrobat/readermain.html
Your Toe Amputation Operation
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 into your toe 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 toe.
Sometimes the toe has shrivelled up and is a nuisance.
Sometimes more than one toe needs to come off.
Sometimes the operation is done at the same time as an operation on the blood vessels.
What does the operation consist of?
You have an anaesthetic and we take off your toe. We may need to take off some of the skin from the foot near the toe to get the best healing.
Usually we can stitch the skin up over the wound after removing the toe.
Sometimes it is better to let the wound heal up by itself without any stitches. This takes 3 or 4 weeks or more.
Are there any alternatives?
If you leave things as they are, your toe will certainly get worse. Infection may spread to your other toes and foot.
An operation to bypass or core out your leg arteries will not work in your case.
Laser treatment and x-ray guided stretching of the arteries will not work for you.
Injecting the nerve to your blood vessels will not work.
Antibiotics are not enough by themselves.
An alternative to a toe amputation is an amputation higher up. This may heal up better at the cost of loss of part of your limb.
Amputations through the foot do not heal very much better than toe amputations, but an amputation just below your knee would heal very well.
Overall, I think your best plan is a toe amputation at the present moment.
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 and 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.
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.
Shaving
Excess hair will be shaved off.
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.
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 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. If you are having a general anaesthetic, you will go off to sleep.
You may be given a local anaesthetic injection into the foot or one into the back to make the whole limb numb if the anaesthetist thinks this would be best. He will talk to you about it.
The operation is then performed.
What happens after the operation?
Coming round after the anaesthetic
Although you will be conscious a minute or two after the operation ends, you are unlikely to remember anything until you are back in your bed on the ward. Some patients feel a bit sick for up to 24 hours after operation, but this passes off. You will be given 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.
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.
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.
You will be expected to get out of bed the day after operation despite the discomfort. You will not do the wound any harm, and the exercise is very helpful for you.
The second day after operation you should be able to spend most of your time out of bed and in reasonable comfort. You should be able to walk slowly along the corridor.
By the end of one week the wound should be virtually pain-free.
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.
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 that you pass urine and empty your bladder within 6-12 hours of the operation. If you find using a bed pan or a bottle difficult, the nurses will assist you to a commode or the toilet.
If you still cannot pass urine let the nurses know and steps will be taken to correct the problem.
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 and that you are helping your circulation by continuous movement of body and limbs.
The wound and stitches
The wound has a dressing which may show some staining with old blood in the first 24 hours. We will look at the wound after a week.
There may be stitches in the wound which will be removed after 10 days.
If the wound has not been stitched it will be redressed from time to time.
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 and doctors will keep your relatives and contacts up to date with your progress.
How long in hospital?
This depends very much on your general condition. Ideally you can go home after a day or so. Often patients find it more convenient to stay for a week or longer.
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.
Sick notes
Please ask the nurses for sick notes, certificates etc.
After you leave hospital
You should feel well within a week of the operation.
Lifting
You can lift anything you want once the wound is comfortable.
Driving
You can drive as soon as you can make an emergency stop without discomfort in the wound and the wound is healed. i.e. after about 4 weeks.
What about sex?
You can restart sexual relations within a week or two, when the wound is comfortable.
Work
You should be able to return to a your job when the wound is healed.
Complications
Delayed healing sometimes happens. We will talk to you about this.
If you think that all is not well, please ask the nurses or doctors.
Infection is sometimes seen. You will be given antibiotics to prevent this.
Aches and twinges may be felt in the wound for up to 6 months.
Occasionally there are numb patches in the skin around the wound which get better after 2 to 3 months.
General advice
The operation is a small one and usually causes no problems.
However trouble with your circulation or diabetes causing the toe to be diseased needs very careful watching.
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.
