Patients with a severe case of diabetes-related ulceration may require minor amputation to minimise the infection from spreading to other parts of the body.
The most common amputation in diabetes is toe amputation (minor amputation).
Below knee and above knee amputations (major amputation) are often required to preserve the unaffected bones and tissue in the patient’s leg. This is usually the case in advanced ulceration affecting feet, frequently associated with very poor blood supply where treatment options are very limited or not possible at all.
Patients undergoing amputations are likely to require special preparation. You may be required to reduce or stop taking certain medications leading up to the amputation, to reduce the risk of bleeding or other complications.
Your physical strength, balance and coordination may also be tested prior to the amputation to assess your potential for rehabilitation. If you are going to use an artificial limb following your amputation, you may be required to undergo a fitting to ensure the artificial limb is ready by the time you recover from your operation.
The operation itself involves removing the diseased limb, yet preserving as much healthy skin, blood vessel, and nerve tissue as possible.
When the anaesthesia has taken effect, the surgeon makes an incision into the skin, leaving enough healthy skin to cover the stump for healing. Major blood vessels are clamped to minimise bleeding, and nerves are protected while the operation is carried out.
The surgeon may shape the muscles to create a comfortable contour for your artificial limb (if required), and when the surgeon is satisfied that the diseased tissue has been successfully removed, they will stitch the blood vessels and remove the clamps to ensure that all bleeding points are secure.
Depending on the severity of the infection, the surgeon may leave the site open for several days to allow the surgical team to clean and eradicate the infection. This is called an open flap amputation.
Closing the skin flaps immediately after the limb has been removed (closed amputation) means the surgeon is confident that the infected tissue has been removed and successful healing is likely.
Your surgical team may place a stocking over the stump to hold drainage tubes and wound dressings in place, or your limb may be placed in traction or a splint, depending on your condition.
You will be required to stay in hospital from 5 to 14 days after your operation, and full healing can be expected in 4 to 8 weeks.
Counselling before and after your amputation is advised to support you through this major life change.
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Amputation may be recommended when a limb cannot be saved due to severe infection, gangrene, critical ischaemia that cannot be revascularised, or significant trauma. The goal is to remove non-viable tissue to preserve life and enable rehabilitation. Every effort is made to avoid amputation through revascularisation when possible.