Amputation Prevention

How can major amputations be prevented?

The estimated risk for major amputation in the individual with diabetes is 15-40X higher than the general population. This risk can be reduced by awareness, lifestyle modification, careful blood sugar control, good skin care and pressure reduction footwear.

Despite these preventive measures limb threatening wounds and infections do develop. A coordinated surgical approach optimizes the prospects of limb salvage in these difficult situations.

Amputation may be unavoidable in some patients. However, an experienced surgical team will be able to preserve length and number of functioning joints to maximize motion in the extremity. Individuals with amputations of the distal third of the foot (transmetatarsal level) often achieve near normal mobility with the aid of a custom insole. As the amputation level rises so does the energy expenditure necessary to walk. A below knee amputation (BKA) requires a 25% increase in energy expenditure to ambulate. Walking with an above knee amputation (AKA) requires 65% more energy than the normal state. Clearly, reducing the level of amputation is an important goal for an individual's long-term function.

The surgical team assembled by the Limb Center has expertise in othopedic, plastic and vascular surgery. A coordinated approach is frequently necessary achieve limb salvage. An angioplasty or vascular bypass may be required to enhance local circulation. Bone grafting contouring and fusion may also be indicated. Tendons may be rerouted or lengthened to enhance motion and balance the foot. Soft tissue may be required to cover exposed bones, nerves and tendons while providing durable padding. Local skin and muscles (local flap) may be shifted to fill the defect or new tissue imported from a distant site utilizing microvascular techniques (free flap). The transplantation of expendable muscle or skin segments from an area of relative excess to the lower extremity is a powerful reconstructive tool. A microvascular connection must be created between the transferred tissue and local blood vessels in the new location. The connections are created under a powerful microscope with stitches finer than a hair. These techniques are complex and best performed at a dedicated center by an experienced reconstructive microsurgeon.

In some patients distant amputation levels cannot be preserved, however, significant benefit can still be gained by creation of a well-padded, durable stump. A dedicated lower extremity surgeon working in close association with a prosthetist and physical therapist can ease the road to recovery.