Above The Knee Amputation

WHAT YOU SHOULD KNOW:

• Above the knee amputation is surgery to remove your leg above your knee cap. It is also called AKA. You may need an AKA 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 an AKA if you have cancer, or were born with a deformed leg. Amputations are either planned or done in an emergency. Caregivers will only remove as much of you leg as is absolutely necessary. After an AKA, you may be fitted for a prosthesis (artificial leg) for your residual (remaining) limb.
  
  
• You and your caregiver will work together to decide if other treatments should be included in your treatment plan. You may need hyperbaric oxygen treatment to help heal infections. You may need surgery to provide new blood vessels to your leg if you have blood flow problems. If you have cancer, you may need surgery to remove the tumor and graft a donor bone in its place.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

• During or after surgery, you may bleed more than usual. Blood may collect under your skin and form a lump called a hematoma. This may need to be drained to prevent infection. It may be difficult for your wound to heal and you may get a wound infection. You may get a blood clot in your leg or arm. This can cause pain and swelling, and it can stop blood from flowing where it needs to go in your body. The blood clot can break loose and travel to your lungs or brain. A blood clot in your lungs can cause chest pain and trouble breathing. A blood clot in your brain can cause a stroke. These problems can be life-threatening.
  
  
• Some people continue to feel the part of their leg that has been amputated. These are called phantom feelings. These feelings are normal and may or may not be painful. If you do not have surgery, your problem could get worse. If you have cancer or a badly infected leg and do not get treatment, with time you could die. Call your caregiver if you are worried or have questions about your medicine or care.

WHILE YOU ARE HERE:

Call button:

You may use the call button when you need your caregiver. Pain, trouble breathing, or wanting to get out of bed are good reasons to call. The call button should always be close enough for you to reach it.

Gown:

A hospital gown is needed so that caregivers can easily check and treat you. Caregivers will show you how to put on your gown. You may not be allowed to wear your own bedclothes or undergarments to the operating room. This is because you may need monitors on your skin during surgery. When you feel better you may be able to wear your own bedclothes.

Informed consent:

A consent form is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.

IV:

An IV (intravenous) is a small tube placed in your vein that is used to give you medicine or liquids.

Pre-op care:

You may be given medicine right before your procedure or surgery. This medicine may make you feel relaxed and sleepy. You are taken on a stretcher to the room where your procedure or surgery will be done, and then you are moved to a table or bed.

• Angiogram: This is a test that may be needed to check the blood flow in your leg. A catheter (thin tube) is threaded into an artery in your groin (the area where your thigh meets your belly). Dye is put into the catheter. X-rays are then taken to watch how the dye and blood flow through your leg. Another test may be done to test the oxygen levels in your leg. These tests help caregivers decide at what point your leg needs to be amputated.
  
  
• Blood tests: You may need blood taken to give caregivers information about how your body is working. The blood may be taken from your hand, arm, or IV.
  
  
• Blood transfusion: You may need a blood transfusion for certain medical conditions. You may also need a transfusion if you lose a large amount of blood during surgery. You may ask a family member or friend with the same blood type to donate blood for you. This is called directed blood donation. Many people are worried about getting AIDS, hepatitis, or West Nile Virus from a blood transfusion. The risk of this happening is rare. Blood banks test all donated blood for AIDS, hepatitis, and West Nile Virus. If you refuse a blood transfusion, your condition may get worse, and you may die.
  
  
• Chest x-ray: This is a picture of your lungs and heart. Caregivers use it to see how your lungs and heart are doing. Caregivers may use the x-ray to look for signs of infection like pneumonia, or to look for collapsed lungs. Chest x-rays may show tumors, broken ribs, or fluid around the heart and lungs.
  
  
• Heart monitor: This is also called an ECG or EKG. Sticky pads placed on your skin record your heart's electrical activity.
  
  
• Pulse oximeter: A pulse oximeter is a device that measures the amount of oxygen in your blood. A cord with a clip or sticky strip is placed on your finger, ear, or toe. The other end of the cord is hooked to a machine. Never turn the pulse oximeter or alarm off. An alarm will sound if your oxygen level is low or cannot be read.
  
  
• Vital signs: Caregivers will check your blood pressure, heart rate, breathing rate, and temperature. They will also ask about your pain. These vital signs give caregivers information about your current health.
  
  
• General anesthesia: Caregivers use this medicine to keep you asleep and free from pain during surgery. They give you anesthesia through your IV or as a gas. You may breathe in the gas through a mask or through a breathing tube placed down your throat. The tube may cause you to have a sore throat when you wake up.

During Surgery:

• During surgery, caregivers will try to remove the diseased tissue so that your wound will heal well. Caregivers will also try to form your residual (remaining) limb so that a prosthesis will fit well on it. Caregivers will only remove as much of the foot or leg as is absolutely necessary. Caregivers clean your foot and leg with soap and water. This soap may make your skin yellow, but is cleaned off later. Sheets are put over you to keep the surgery area clean.
  
  
• An incision (cut) will be made in your leg above your knee. The part of your leg below that will be removed, and your thigh bone will be made smooth. A flap, made of muscle, tissue, and skin will be made to cover the end of your bone. Tissue for the flap may come from other parts of your leg or foot. If your leg was infected before surgery, caregivers may not put sutures (thread) or staples in to close it right away. The incision may be left open for several days after surgery. If no infection was present, the flap will be closed with stitches. These stitches may be taken out about a month after surgery.
  
  
• A soft or hard bandage is put over your residual limb. If the incision was left open, a soft bandage is used, and covered with an elastic wrap. If the incision was closed with stitches, a cast is put over the bandage. The cast decreases swelling after surgery and protects your residual limb from injury. The cast also makes fitting for a prosthesis easier and quicker. A prosthesis may be put on right after surgery.

After Surgery:

You are taken to a room where you will stay until you wake up. Then you will be taken to your room. Do not try to get out of bed until your caregiver says it is OK. A bandage is used to cover your stitches or staples. The bandage keeps the area clean and dry to prevent infection. A caregiver may remove the bandage soon after surgery to check your incision.

Activity guidelines:

• Change your position often while resting in bed. This moves fluids in your lungs, helping decrease your chance of getting pneumonia. This also helps prevent skin pressure sores, and keeps your muscles and tendons from tightening.
  
  
• While you are in bed, keep your residual limb raised on one to two pillows for the first 24 hours after surgery. This helps decrease swelling.
  
  
• After the first day, keep your residual limb flat on the bed to prevent your hip from tightening.
  
  
• Lie on your stomach twice a day. This also helps prevent hip tightening.
  
  
• Start exercising your good leg and residual limb as soon as caregivers say it is OK. Lift your leg off the bed and move it in big circles. This helps strengthen your leg, and may prevent blood clots from forming. Repeat with your residual limb. Stop exercising if you become tired.

Balance and strength exercises:

• The center of gravity in your body will change because you suddenly weigh less after an amputation. You will have to learn your new center of gravity so that you can keep your balance. Caregivers will help you sit up and transfer to a chair one or two days after surgery. They will teach you how to stand up holding onto the chair for balance and support. If you ever feel weak or dizzy, sit or lie down right away. Then call your caregiver.
  
  
• Caregivers will help you carefully do exercises to strengthen your muscles and improve your balance. Do these exercises while holding onto the chair. Be careful not to hit your residual limb on the chair while doing these exercises.
  
  
  • Stand on your toes.
    
    
  • Do knee bends.
    
    
  • Hop on your foot.
    
    
  • Practice standing without holding on to the chair.

Prevent constipation:

High-fiber foods, extra liquids, and regular exercise can help you prevent constipation. Examples of high-fiber foods are fruit and bran. Prune juice and water are good liquids to drink. Regular exercise helps your digestive system work. You may also be told to take over-the-counter fiber and stool softener medicines. Take these items as directed.

Deep breathing and coughing:

This is an exercise to help decrease your risk for a lung infection after surgery. Do the following:

• Hold a pillow tightly against your incision (cut) when you cough to help decrease pain. Take a deep breath and hold it for as long as you can. Deep breathes help open the airways that lead to your lungs. Let the air out and follow with a strong cough. Spit out any mucus you cough up. Repeat the steps 10 times every hour.
  
  
• You may be given an incentive spirometer to help you take deeper breaths. Put the plastic piece into your mouth and take a very deep breath. Hold your breath as long as you can. Let out your breath and cough. Repeat the steps 10 times every hour.

Food and drink after surgery:

You will able to drink liquids and eat certain foods once your stomach function returns after surgery. You may be given ice chips at first. Then you will get liquids such as water, broth, juice, and clear soft drinks. If your stomach does not become upset, you may then be given soft foods, such as ice cream and applesauce. Once you can eat soft food easily, you may slowly begin to eat solid foods.

Drinking liquids:

Men 19 years old and older should drink about three Liters of liquid each day (about 13 eight-ounce cups). Women 19 years old and older should drink about two Liters of liquid each day (about 9 eight-ounce cups). Follow your caregiver's advice if you must change the amount of liquid you drink. For most people, healthy liquids to drink are water, juices, and milk. If you are used to drinking liquids that contain caffeine, such as coffee, these can also be counted in your daily liquid amount. Try to drink enough liquid each day, and not just when you feel thirsty.

Drains:

These are thin rubber tubes put into your skin to drain fluid from around your incision. The drains are taken out when the incision stops draining.

Foley catheter:

This is a tube caregivers put into your bladder to drain your urine into a bag. Keep the bag below your waist. This will help prevent infection and other problems caused by urine flowing back into your bladder. Do not pull on the catheter, because this may cause pain and bleeding, and the catheter could come out. Keep the catheter tubing free of kinks so your urine will flow into the bag. Caregivers will remove the catheter as soon as possible, to help prevent infection.

Intake and output:

Caregivers will keep track of the amount of liquid you are getting. They also may need to know how much you are urinating. Ask how much liquid you should drink each day. Ask caregivers if they need to measure or collect your urine.

Medicines:

• Antibiotics: This medicine is given to help treat or prevent an infection caused by bacteria.
  
  
• Antinausea medicine: This medicine may be given to calm your stomach and to help prevent vomiting.
  
  
• Pain medicine: Caregivers may give you medicine to take away or decrease your pain.
  
  
  • Do not wait until the pain is severe to ask for your medicine. Tell caregivers if your pain does not decrease. The medicine may not work as well at controlling your pain if you wait too long to take it.
    
    
  • Pain medicine can make you dizzy or sleepy. Prevent falls by calling a caregiver when you want to get out of bed or if you need help.
  
  
• Patient controlled analgesia: This is also called "PCA". Caregivers may put a machine on your IV pole that puts pain medicine into your IV. You may be taught how to give yourself the pain medicine by pushing a button whenever you feel pain.
  
  
• Stool softeners: This medicine makes it easier for you to have a bowel movement. You may need this medicine to treat or prevent constipation.

Oxygen:

You may need extra oxygen if your blood oxygen level is lower than it should be. You may get oxygen through a mask placed over your nose and mouth or through small tubes placed in your nostrils. Ask your caregiver before you take off the mask or oxygen tubing.

Physical therapy:

A physical therapist helps you with special exercises. These exercises make your bones and muscles stronger and help you learn to do things for yourself again after an amputation. You will be taught how to use crutches or a walker. With time, you may also be taught how to walk with a prosthesis (artificial leg).

Pressure stockings:

A pressure stocking may be put on your good leg. This tight elastic stocking keeps blood from staying in your leg and causing blood clots. The stockings are also called Ted Hose® or Jobst Stockings®. These stockings can help to keep you from getting blood clots.

Pneumatic boots:

A pneumatic boot or legging may be put on your good foot or leg over a pressure stocking or ace wrap. The boot or legging is connected to an air pump machine. The pump tightens and loosens different parts of the boot or legging. This helps push the blood back up to your heart to keep clots from forming. They have many names such as Pneumo Boots®, SCDs, or Plexi Pulse®.

Wrapping your residual limb:

Caregivers will teach you or a family member how to wrap your residual limb with an elastic bandage. Doing this helps to control swelling, and helps to form the residual limb into a firm cone shape. This shape will fit into a prosthesis. Caregivers may start wrapping your residual limb within one to three days after surgery, or they may wait until the cast is removed. Wrapping is started low on your residual limb, away from your groin (where your abdomen meets your upper leg). A "figure of 8" method may be used to wrap your residual limb. At first they will not pull the elastic bandage very tight. Caregivers will pull the bandage tighter as your wound heals and the stitches are removed.

• Your caregiver will rewrap your residual limb about every 4 hours to keep the bandage smooth and tight.
  
  
• Ask your caregiver to rewrap the bandage if your pain is worse. This may mean the bandage is too tight.

"Figure of 8" method to wrap your residual limb:

• Hold the bandage roll at your side, and at your waistline. (If your residual limb is on the left, hold the bandage at your left side. If your residual limb is on your right, hold the bandage at your right side.)
  
  
• Starting at the front of your body; begin unrolling the bandage around your waist. When you have completely circled your waist, turn the bandage so that it goes down, past your groin on the inside of your thigh, to the back of your limb.
  
  
• Roll the bandage down your limb, and around the end of your limb. Bring the bandage back up the front of your limb. Partly overlap the bandage as you wrap, so that you are always covering new skin surface.
  
  
• Roll the bandage up your leg, toward your waist. Roll the bandage around the back of your waist, in the same direction as the first time. Repeat the steps until there are no visible skin areas.

• Helpful hints:
  
  
  • While you are unrolling and using an elastic bandage, stretch the bandage slightly while wrapping your limb.
    
    
  • If you need to use more than one bandage, secure each bandage with a clip or tape before applying another one. When you are finished, secure the last bandage. When securing the end of a bandage using clips, try to end the bandage in a place that is not in a skin fold.
    
    
  • Be sure that all of your skin is covered with the bandages. Bandages should cover your limb from the top of your thigh to the end of your limb.
    
    
  • Keep the bandage on at all times except when bathing.
  
  

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

Learn more about Above The Knee Amputation (Inpatient Care)