Consent: Lower Limb Amputation

Original Author: Ollie Jones
Last Updated: February 14, 2019
Revisions: 7

This article is for educational purposes only. It should not be used as a template for consenting patients. The person obtaining consent should have clear knowledge of the procedure and the potential risks and complications. Always refer to your local or national guidelines, and the applicable and appropriate law in your jurisdiction governing patient consent.

Overview of Procedure

The most common types of lower limb amputation are digits, hallux, forefoot, below knee, and above knee amputations.

These can either be achieved primarily by creating a flap to cover the stump (a long posterior flap or skew flap in below knee amputations) or by guillotine (in cases of severe infection to remove the pus) and creating a stump at a later stage.


Intra-Operative

Complication Description of Complication Potential Ways to Reduce Risk
Haemorrhage This procedure necessitates careful dissection and tying off of major vessels to prevent major blood loss. A tourniquet can be used, however if the procedure is being performed due to arterial insufficiency it is usually not required
Anaesthetic Risks Includes damage to the teeth, throat and larynx, reaction to medications, nausea and vomiting, cardiovascular and respiratory complications. Forms a part of the anaesthetist assessment before the operation

Early

Complication Description of Complication Potential Ways to Reduce Risk
Pain The patient will most likely have an epidural to minimise post-operative pain, as well as a perineural nerve catheter inserted to give local anaesthetic directly into the nerve for major amputations.
Bleeding There is a small chance of bleeding and bruising in the stump post-surgery.
Infection Superficial wound infection is possible and can threaten the integrity of the stump. Peri-operative antibiotics will reduce the risk of wound and stump infections
Scarring . It is important to measures flaps accurately to minimise unsightly scars, and position them off of weight bearing areas
Blood clots DVTs and PEs are a possibility in any operation. The risk is increased in patients with a raised BMI, on the pill, recent flights, previous DVT, pregnancy, smokers, cancer and prolonged bed rest. The patient will be given anti-embolism stocking and low molecular weight heparin peri-operatively to minimise this risk as deemed appropriate.
Stroke, MI, Kidney Failure, Death Although small, this is always a risk in any major surgery

Late

Complication Description of Complication Potential Ways to Reduce Risk
Phantom limb Patients can report that the removed limb remains attached, particularly feelings of pain and itching in the removed limb. Neuropathic analgesics, such as pregabalin and amitriptyline, can help with these symptoms
Reintervention Occasionally amputation sites do not heal and require further more proximal amputation.

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