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Adult Medical-Surgical
Nursing
Musculo-skeletal Module:
Amputation
Amputation: Description
 Amputation
is removal of a body part
usually part or whole of an extremity
(limb)
Amputation: Causes
 Progressive
peripheral vascular
disease (often a complication of
Diabetes Mellitus: “Diabetic foot”)
 Trauma: crush injury, burn injury
including electrical, frostbite
 Chronic osteomyelitis
 Gas gangrene
 Malignant tumour
 Congenital deformity
Aim of Amputation
 To
save life where gangrene
(inadequate circulation) infection or
malignancy will spread
 To preserve as much viable healthy
limb as possible
 To relieve symptoms
 To improve function
 To improve quality of life
Levels of Amputation
 Aim
to conserve as much limb as
possible and to preserve joints
 Surgery at the most distal point of
limb which will heal successfully
 Depends on:
 Circulatory status of extremity
 Appropriate level for fitting
prosthesis
Pre-operative Assessment
 Age
of patient and general health
 Current medications
 Psychological impact of proposed
surgery
 Circulatory status of affected limb:
 Doppler flowmetry
 Segmental BP
 Transcutaneous partial pressure O2
(PaO2)
 Related muscle and joint function
Amputation: Complications
 Haemorrhage
 Infection
 Skin
breakdown/ delayed healing
 Phantom limb pain (tingling pain as if
limb still present)
 Joint contracture
 Severe depression and grief over
permanent loss of limb, altered body
image and modification of lifestyle
Amputation:
Post-operative Nursing Care
 Adequate
hydration/ nutritional
status
 Aseptic technique
 Monitor wound healing, presence of
oedema/ infection/ skin breakdown
 Monitor for onset of complications
 Tourniquet available in case of
severe haemorrhage
 Assess mood
Amputation: Care of Limb
 Reduce
oedema (delays healing):
 Elevate limb (avoid placing lower
limb on pillow. Risks flexion
contracture of hip joint. Rather raise
foot of bed)
 Constant pressure bandage: (molds
stump for prosthesis)
 Range of motion exercises/ change
of position:
 Strengthens and molds muscles of
stump
 Prevents flexion contracture of joint
Amputation: Phantom Pains
 Monitor
for phantom pains
 Address by:
 Massage
of stump to mold for
prosthesis and desensitisation with:
 Transcutaneous electrical nerve
stimulation (TENS)
 Local anaesthetic
 β-blocker medication
Amputation: Rehabilitation
Multi-disciplinary rehabilitation team
(patient, physician, nurse,
physiotherapist, psychologist, occupational
therapist)
 Early application of prosthesis as soon as
stump formed
 Early usage/ ambulation (↑ muscle tone)
 Counselling, encouragement, support for
grieving process, lifestyle changes
