Chapter 18: Indications and Management of Lower Limb Amputation

The following sections are included:

• Peripheral vascular disease is the leading cause of amputation in the Western world.

• Diabetics are 8–12 times more likely to suffer amputation.

• Mortality and subsequent loss of the contralateral limb following amputation are high.

• The level of amputation requires careful consideration of the rehabilitative potential of the patient, level and pattern of vascular disease and likely healing.

• Careful pre-operative assessment and peri-operative care using the multidiscliplinary team is essential for successful outcomes.

• Epidural analgesia provides the best peri-operative analgesia, but does not prevent subsequent phantom pain.

• The general principles of amputation surgery apply to all sites of amputation.

• Rehabilitation of the patient should start immediately post-operatively.

• Post-amputation pain is the commonest post-operative complication, is multifactorial and requires thorough assessment and possible onwards referral to a multidisciplinary pain team for management.

• Phantom limb pain is common and effective treatments remain elusive.