Lower limb amputation

Abstract

Peripheral arterial disease (PAD) and diabetes are the leading cause of lower limb amputation worldwide (other significant causes are neuropathy and trauma). With our ageing population, many patients with these conditions are frail, comorbid individuals with limited or no arterial reconstructive options. Therefore, a thorough grounding in the indications for lower limb amputation and all perioperative considerations that accompany it remain a high priority for surgeons. Minor lower limb amputations are characterized by removal of the toe(s), forefoot, midfoot or hindfoot. Major lower limb amputations (MLLAs) involve a significant part of the limb being removed, and include below-, through- and above-knee amputations. Hip disarticulations and hindquarter amputations are discussed here but infrequently used in practice. Shared decision making should be utilized to ensure a well-informed and prepared patient. A cohesive MDT approach is vital to provide ideal perioperative care and follow-up to patients undergoing amputation. Focus should be paid to optimization of comorbidities such as diabetes, respiratory compromise and coagulopathies, and to postoperative rehabilitation including prosthesis. The overall aim for amputation surgery is to remove non-viable/non-salvageable tissue whilst maintaining sufficient tissue for good wound healing and maximizing the potential for ambulation.