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JOAQUIN, JEWEL A. Mrs. Judith Cartagena RN, MANBSNIII-A

Bel ! "he #nee A$%utati n

Below the knee amputation is surgery to remove all or part of your foot or your leg below the knee cap. It is also called BKA. Youmay need a BKA for a health problem that causes poor blood flow, such as diabetes. You may have a severe infection or a blood clot.You may have been in an accident that injured your leg beyond repair. You may also need a BKA if you have cancer, or were bornwith a deformed leg. Amputations are either planned or done in an emergency. aregivers will only remove as much of your foot orleg as is absolutely necessary. After a BKA, you may be fitted for a prosthesis !artificial leg" for your residual !remaining" limb.

Amputation is the intentional surgical removal of a limb or body part. It is performed to remove diseased tissue or relieve pain.

&ur% seArms, legs, hands, feet, fingers, and toes can be amputated. #ost amputations involve small body parts such as a finger, rather than anentire limb. About $%,&&& amputations are performed in the 'nited (tates each year.Amputation is performed for the following reasons)

• to remove tissue that no longer has an ade*uate blood supply• to remove malignant tumors

• because of severe trauma to the body part

+he blood supply to an e tremity can be cut off because of injury to the blood vessel, hardening of the arteries, arterial embolism , impaired circulation as a complication of diabetes mellitus , repeated severe infection that leads to gangrene , severe frostbite,-aynaud s disease, or Buerger s disease.

#ore than /&0 of amputations performed in the 'nited (tates are due to circulatory complications of diabetes. (i ty to eighty percent

of these operations involve the legs or feet. Although attempts have been made in the 'nited (tates to better manage diabetes and thefoot ulcers that can be complications of the disease, the number of resulting amputations has not decreased.

&re'auti nsAmputations cannot be performed on patients with uncontrolled diabetes mellitus, heart failure, or infection. 1atients with bloodclotting disorders are also not good candidates for amputation.

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(es'ri%ti nAmputations can be either planned or emergency procedures. Injury and arterial embolisms are the main reasons for emergencyamputations. +he operation is performed under regional or general anesthesia by a general or orthopedic surgeon in a hospitaloperating room.2etails of the operation vary slightly depending on what part is to be removed. +he goal of all

A$%utati n ) leg. *igure A+ A)ter the surge n 'reates t! )la%s ) s in and tissue, the $us'le i s 'ut and the $ain arter and eins ) the )e$ur / ne aree0% sed. *igure B+ "he surge n se ers the $ain arter and eins. Ne! ' nne'ti ns are ) r$ed /et!een the$, rest ring /l d 'ir'ulati n. "he s'iati' ner e isthen %ulled d !n, 'la$%ed and tied, and se ered. *igure C+ "he surge n sa!s thr ugh the e0% sed )e$ur / ne. *igure (+ "he $us'les are 'l sed and sutured

er the / ne. "he re$aining s in )la%s are then sutured t gether, 'reating a stu$%.!

amputations is twofold) to remove diseased tissue so that the wound will heal cleanly, and to construct a stump that will allow theattachment of a prosthesis or artificial replacement part.+he surgeon makes an incision around the part to be amputated. +he part is removed, and the bone is smoothed. A flap is constructedof muscle, connective tissue, and skin to cover the raw end of the bone. +he flap is closed over the bone with sutures !surgical stitches"that remain in place for about one month. 3ften, a rigid dressing or cast is applied that stays in place for about two weeks.

&re%arati nBefore an amputation is performed, e tensive testing is done to determine the proper level of amputation. +he goal of the surgeon is tofind the place where healing is most likely to be complete, while allowing the ma imum amount of limb to remain for effectiverehabilitation.

+he greater the blood flow through an area, the more likely healing is to occur. +hese tests are designed to measure blood flow throughthe limb. (everal or all of them can be done to help choose the proper level of amputation.

• measurement of blood pressure in different parts of the limb• enon 455 studies, which use a radiopharmaceutical to measure blood flow

• o ygen tension measurements in which an o ygen electrode is used to measure o ygen pressure under the skin. If the pressure is &, the healing will not occur. If the pressure reads higher than 6&mm 7g !6& milliliters of mercury", healing ofthe area is likely to be satisfactory.

• laser 2oppler measurements of the microcirculation of the skin

• skin fluorescent studies that also measure skin microcirculation

•

skin perfusion measurements using a blood pressure cuff and photoelectric detector • infrared measurements of skin temperature

8o single test is highly predictive of healing, but taken together, the results give the surgeon an e cellent idea of the best place toamputate.

A)ter'areAfter amputation, medication is prescribed for pain, and patients are treated with antibiotics to discourage infection. +he stump ismoved often to encourage good circulation. 1hysical therapy and rehabilitation are started as soon as possible, usually within 69 hours.(tudies have shown that there is a positive relationship between early rehabilitation and effective functioning of the stump and

prosthesis. :ength of stay in the hospital depends on the severity of the amputation and the general health of the amputee, but ranges

from several days to two weeks.

-ehabilitation is a long, arduous process, especially for above the knee amputees. +wice daily physical therapy is not uncommon. Inaddition, psychological counseling is an important part of rehabilitation. #any people feel a sense of loss and grief when they lose a

body part. 3thers are bothered by phantom limb syndrome, where they feel as if the amputated part is still in place. +hey may evenfeel pain in the limb that does not e ist. #any amputees benefit from joining self;help groups and meeting others who are also livingwith amputation. Addressing the emotional aspects of amputation often speeds the physical rehabilitation process.