Preparing for your amputation surgery.

One of the most common causes of amputations in the Western world result from occlusive arterial diseases. With a circulatory disorder, the supply of oxygen to the leg is no longer sufficient, and those affected often experience pain and find walking uncomfortable. Their leg or foot may feel colder than the rest of the body and sometimes appear 'bluish' in colour. A lower limb amputation is only performed if blood circulation cannot be restored by other vascular surgery procedures.

Diabetic foot syndrome (DFS) is one of the most common causes for leg or foot amputations. Though the number of people with diabetes is rising, the number of amputations is changing very little, as a result of better ways of controlling the disease, treatment methods and knowledge.

• High blood sugar levels can damage the nerves and blood vessels in your body. If the nerves in your legs or feet become damaged (neuropathy) you may no longer be able to feel pain, this can then lead to cuts or ulcers going un-noticed resulting in infections.

• Diabetes can sometimes result in less perspiration, this can sometimes cause your feet and legs to dry out and crack.

• Uncontrolled diabetes may also affect circulation, causing blood to move more slowly, which makes it more difficult for the body to deliver nutrients to wounds, affecting wound healing.

The frequency of amputations after accidents – including work and traffic accidents, for example – has decreased considerably in the Western world. There are many reasons for this, including higher occupational health and safety standards as well as advances in medical treatment. Progress in the fields of intensive care and surgery means that the nerves, vessels, bones and soft tissue of injured limbs can be restored in many cases, so now an amputation is not always required as the last resort.

Amputations due to cancer are relatively rare. However, tumours close to the knee or in the area of the hip result are the most common to result in amputation. This occurs when the tumour needs to be removed to save a patient's life and prevent the spread of cancer cells that can affect other parts of the body.

Any would is open to infection, however, amputations resulting from infections have become extremely rare since Louis Pasteur discovered antibiotics in 1877. High sterile standards in medical treatment and tetanus shots are another reason for the decrease. Nevertheless, remaining vigilant even with the tiniest injury and looking out for signs of inflammation, reddening of the skin, swelling, fever and pain in a wound can help.

The surgeon advises you before the amputation and performs the operation. Ideally, the surgeon will work with your O&P professional to coordinate the course of the operation in advance. For example, the surgeon and O&P professional can discuss the shape of your residual limb ahead of time, which makes the subsequent fitting of your prosthetic socket easier. After the amputation, the surgeon monitors your recovery and prescribes rehabilitation.

In most cases, your general practitioner and specialist have looked after you even before the amputation and are familiar with the course of your illness. They are available when you need prescriptions for new prosthetic components or additional rehabilitation measures.

A social education worker or other social services employee usually looks after you while you are still in hospital. Their task is to help you during your return to everyday life. This includes topics such as your home, education, work, family, income and social networks. They tell you what services are available and how you can access them. Examples of services include medical, special and social education measures or assistance for participation in social life.

After your amputation, the nursing staff in the hospital will look after your wound healing and ensure the correct positioning and compression of your residual limb. Ideally, this will be coordinated with your surgeon, prosthetist and physiotherapist.

Physiotherapists and occupational therapists assist you in the hospital, during rehabilitation and in everyday life. Their task is to get you moving, to strengthen and stretch your musculature, and to help you learn and make further improvements in walking and coping with activities of daily living. Therapists also do compression therapy in the hospital.

Your prosthetist will play central role after your amputation surgery. They will fit you with a suitable prosthesis and can offer advice if you have questions. Leading up to an amputation, your prosthetist may discuss with your surgeon what your residual limb should look like if possible. They can recommend experienced physiotherapists and put you in contact with other amputees. You can also ask them about things like a contact for home conversions or vehicle alterations.

When fitting you with a prosthesis, your prosthetist will clarify your needs and preferences and discuss the various treatment options with you. Based on this, they select the appropriate prosthetic components and fabricate your prosthesis with a customised prosthetic socket.

Your prosthetist is available to you for all questions related to your prosthesis.

In addition to the prosthesis, you may need appropriate shoes for your sound foot. This may be the case if you have a circulatory disorder, for example. Orthopaedic shoes may also be an option for you with a partial foot amputation if you do not wear a partial foot prosthesis. Ask your O&P professional for contact information.

Depending on your family situation, outpatient nurses can assist you with using the prosthesis and also take charge of compression and mobilisation in everyday life.