Lower leg amputation

What is a lower leg amputation?

A lower leg amputation is usually understood to be an operative separation of the leg below the knee joint.
The function of the knee joint is normally retained, so that in most cases a fitting with an adapted prosthesis can be provided. An amputation is necessary either after a serious accident in which the lower leg was injured to such an extent that it cannot be preserved, or in the case of a severe circulatory disorder, which usually occurs as part of a “smoker's leg” with severe hardening of the arteries.
If the lower leg is separated from the body by an accident rather than an operation, this is also referred to as a lower leg amputation.

Indication for a lower leg amputation

There are essentially two types of indications for which a lower leg amputation may be indicated. On the one hand, after a serious accident, for example in traffic, it may be necessary to amputate the leg below the knee joint if the injury is so severe that there is no longer any prospect of the leg healing. On the other hand, there are diseases that may require amputation of the lower leg due to insufficient blood supply to the tissue.

In most cases, the indication is due to calcification of the blood-supplying arteries in the legs, which is also known as peripheral arterial occlusive disease (PAD) or, in popular parlance, “intermittent claudication”. A lower leg amputation is often preceded by a long path of suffering and often the toes or parts of the foot have already been amputated beforehand. Also in the context of a leg ulcer, the so-called open leg, in the case of circulatory disorders, it may be necessary to amputate, especially in the case of severe infections in these areas.

There are other illnesses or circumstances that may also require a lower leg amputation due to an insufficient supply of nutrients and oxygen. These include, for example, chronic and non-healing as well as inflamed wounds. Often there is also diabetes mellitus (“diabetes”), in which nerves and blood vessels are destroyed in the foot and leg. The indication for a lower leg amputation is usually only made if there is no prospect of saving the affected part of the body and less radical measures such as a forefoot amputation are considered insufficient.

Also read the article on the topic: Causes of an amputation

preparation

Preparing for a lower leg amputation requires clarification of the underlying cause and the necessity of this procedure in a way that is understandable for the patient. The operation requires an inpatient hospital stay of several days or weeks, which usually begins the day before the operation.

The treating physicians may pause medication or start new ones. Blood values ​​such as the ability to clot and the level of red blood pigment are determined. In addition, the side of the body to be operated on is usually marked with a pen. Before the operation, it is important to stay sober, i.e. not to eat anything several hours beforehand and finally not to drink anything. The ward doctor or nurse will point this out explicitly.

Procedure of the operation

At the beginning of the process of a lower leg amputation, there are preparations for the operation and the induction of anesthesia. As soon as this is secured, the actual operation can begin. First, an incision is made in the skin with a scalpel. Then the deeper tissue layers are usually exposed with an electric knife. An important part of the lower leg amputation operation is the exposure and exposure of the large blood vessels. These must be reliably closed with tightly knotted sutures to avoid rebleeding.

In addition, nerves on the leg must be found and severed. A local anesthetic is usually injected into the remaining nerve stump. This is intended to reduce pain signals emanating from the nerves after the procedure. In addition, the muscles of the lower leg are severed at certain abutment lines and partially re-attached to the bone. The bones of the tibia and fibula are cut through with a fine saw so that the actual amputation is made possible.

The further process of the lower leg amputation consists of the step-by-step suturing and sealing of the remaining stump. In addition, two so-called drains are usually inserted, which transport wound secretions or blood from the surgical area. These can usually be removed after a few days. The operation ends with the last suture and the application of a sterile bandage to the stump.
The anesthesia is released and the patient is taken to a recovery room for a few hours before being transferred back to the ward.

You may also be interested in this topic: Amputation technique

Risks of the operation

Like any operation, a lower leg amputation is associated with risks. A distinction is made between general risks, as they can occur with almost every procedure, and special risks, which can threaten a lower leg amputation. One of the general dangers is, for example, that the operation can lead to severe blood loss, which may even make it necessary to transfuse blood. It can also injure muscles, nerves or blood vessels.

In spite of all the hygiene measures in the operating room, there is always the risk that the tissue will become inflamed. In addition, every operation increases the risk of developing blood clots, which can lead to pulmonary embolism. Added to this are the possible complications that can arise from the general anesthesia required for the procedure. These include, for example, allergic reactions through to cardiovascular failure. A particular risk with a lower leg amputation and amputations at other heights is the risk that the residual limb will not heal properly. Especially with a circulatory disorder, which is often the reason for a lower leg amputation, there is a risk that there will be difficulties in wound healing.

You might also be interested in this topic: Thigh amputation

Do you need rehab after the operation?

As a rule, you need rehab after a lower leg amputation. This can be done on an outpatient or inpatient basis, depending on the patient's state of health and mobility. The main goals of rehabilitation measures after a lower leg amputation are to support social and professional reintegration, provided the patient is still working.

In the first phase of rehab, the main elements are muscle building, exercise therapy and body training. In addition, intensive stump treatment and care as well as stump shaping using various aids and load simulations are essential. Therefore, an early replacement with a prosthesis is sought. Since the shape of the residual limb can change over time, a transition prosthesis is usually used first.

Read more on the topic:

• Prosthesis supply
• Lower leg prosthesis

What level of care do you get after a lower leg amputation?

After a lower leg amputation, you will not necessarily receive a care level. Despite the limitations of the amputation, many people are in a position to care for themselves or at least do not meet the requirements to receive a care level or degree. A classification is carried out by the medical service of the health insurance companies.

A level of care or a level of care is only given if a certain amount of time per day is required for the basic care of the person concerned, which they cannot afford. A lower leg amputation is one of many factors that must be taken into account. Some people are in need of care after such an operation, while others can continue to take care of themselves.

More on this topic: Care levels and care levels

How long does a lower leg amputation take?

The actual operation for a lower leg amputation usually only takes less than an hour. In addition, however, there are the times for the inpatient hospital stay in preparation for the procedure and the healing phase. Depending on the patient's state of health and the healing process, several days to a few weeks must be planned for.

Thereafter, rehabilitation over several months is usually necessary. It can take months to years for the residual limb to heal completely, for a final prosthesis to be fitted and for you to get used to it. Limitations and consequences of the lower leg amputation such as phantom pain can persist for life.

What amputation techniques are there?

The technique used for a lower leg amputation is basically the same for every operation. The various layers of tissue are cut through, the bones sawn through at a certain height and blood vessels and nerve tracts are tied off. The muscles and skin layers are then sewn together to create a closed stump.

The procedure usually used for a lower leg amputation is also known as the Burgess operation. Differences in the surgical techniques may arise with regard to the height at which the lower leg amputation is carried out, which depends on the indication for the operation (for example a disease with circulatory disorders) and the individual anatomical conditions of the patient concerned.

Read more on the topic: Amputation technique

Can I drive a car after a lower leg amputation?

In principle, you can continue to drive a car after a lower leg amputation. For insurance reasons, however, it is urgently recommended to have a medical certificate issued by a doctor with an additional medical qualification. The costs for this amount to around 150 euros and must be borne by the person concerned.

If you want to switch to a car with the accelerator pedal on the left side after a lower leg amputation of the right leg, you have to complete at least five driving lessons with this constellation if you already have a driving license. This is required by law.
Otherwise there are various options for converting the vehicle so that it can also be steered with a lower leg amputation of the right leg or even with a bilateral amputation. You can get information on this, for example, in a medical supply store or in workshops that carry out such conversions.

What is a lower leg prosthesis?

A lower leg prosthesis is a medical aid that takes over the functions of the missing part of the body after a lower leg amputation.
Most modern prostheses are based on the natural shape of a lower leg and foot, so that they are not immediately noticeable when wearing long trousers. In addition to this optical effect, lower leg prostheses should primarily enable the amputee to be able to walk.

It is necessary that the prosthesis is professionally adapted to the person concerned. In addition, as part of rehabilitation treatment, the patient must learn to handle and walk with the lower leg prosthesis. A well-healed and well-cared-for residual limb is a prerequisite for a restoration with such an aid. Caring for a wound that heals poorly is therefore often difficult.

Find out more about the topic: Prosthesis supply