Amputations of the lower limb: an overview of principles with surgical tips and advances

Amputations are an operation that can strike fear into the heart of a trauma and orthopaedic surgeon with a sense of doom and gloom on occasion for both the surgeon and the patient. At one extreme there may be the emergency life-saving setting, and on the other the more controlled elective setting often following multiple attempted limb-salvage procedures. Either way, there can be a feeling of failure at the end of the treatment road. This need not be the case. Patients coming out of a protracted treatment pathway sometimes wonder why they did not have the limb removed sooner and are usually grateful for the sense of freedom that the operation has given them. This review aims to provide a brief historical perspective through to an update on current techniques with a dedicated discussion around osseointegration. There are suggested techniques, that will provide at the very least a refresher or indeed an alternative thought process to approach both the operation and the patient. Amputations are often the beginning of a new life, but not necessarily the end of the old one.