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Below The Knee Amputation

WHAT YOU SHOULD KNOW:

Below the knee amputation (BKA) is surgery to remove all or part of your foot or your leg below the knee cap.

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 expected. 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:

Before your surgery:

  • Informed consent 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.

  • Pressure stockings: A pressure stocking may be put on your other leg. This tight elastic stocking keeps blood from staying in your leg and causing blood clots. These stockings can keep you from getting blood clots.

  • Pneumatic boots: A pneumatic boot or legging may be put on your other 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.

  • 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.

  • 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. 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.

  • General anesthesia will keep you asleep and free from pain during surgery. Anesthesia may be given through your IV. You may instead breathe it in through a mask or a tube placed down your throat. The tube may cause you to have a sore throat when you wake up.

During your 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. A tourniquet is put on your upper thigh. The tourniquet squeezes your leg tight to decrease bleeding during surgery. Caregivers clean your foot and leg with soap and water. This soap may make your skin yellow, but it is cleaned off later. Sheets are put over you to keep the surgery area clean.

  • An incision (cut) will be made in your leg as far below your knee or in your foot as possible. The part of your leg below that will be removed, and your 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 stitches 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. This 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. You may also have a knee brace to limit movement of your knee. The surgery may last 1 to 2 hours.

After your surgery:

You will be taken to a room where you can rest until you are fully awake. Caregivers will watch you closely for any problems. Do not get out of bed until your caregiver says it is okay. After your caregiver says it is okay, you will be taken back to your hospital room.

  • Deep breathing and coughing: This will help decrease your risk for a lung infection after surgery.

    • Hold a pillow tightly against your incision when you cough to help decrease pain. Take a deep breath and hold it for as long as you can. Deep breaths help open your airways. 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 deep breaths. Put the plastic piece into your mouth and take a slow, deep breath. Let out your breath and cough. Repeat the steps 10 times every hour.

  • 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.

  • A Foley catheter is a tube put into your bladder to drain urine into a bag. Keep the bag below your waist. This will prevent urine from flowing back into your bladder and causing an infection or other problems. Also, keep the tube free of kinks so the urine will drain properly. Do not pull on the catheter. This can cause pain and bleeding, and may cause the catheter to come out. Caregivers will remove the catheter as soon as possible to help prevent infection.

  • 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.

  • Physical therapy: A physical therapist helps you with 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.

  • Activity guidelines:

    • Change your position often while you rest 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 1 to 2 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 other 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.

  • Wrap 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 1 to 3 days after surgery, or they may wait until the cast is removed. Wrapping is started low on your residual limb, away from your groin. 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 on your thigh with one hand. Use the other hand to roll the bandage diagonally down your thigh. Stretch the bandage slightly when you get to the bottom of your limb. Wrap the bandage around the end of the limb.

    • Roll the bandage around to the front. Continue diagonally up your thigh. The bandage will cross over itself. Roll the bandage all the way around the limb and to the front again.

    • Repeat these steps until your limb is completely covered from mid-thigh down. Overlap the bandage as you wrap, so that you are always covering new skin. If you need to use more than one bandage, secure each bandage with a clip or tape before you apply another one.

    • When you are finished, secure the last bandage. Try to end the bandage in a place that is not in a skin fold or at your knee joint.

  • Woolen residual limb socks: Wear a woolen residual limb sock when caregivers say you no longer need to wrap your residual limb. This keeps the limb clean and comfortable. Wash the woolen socks gently in cool water and soap to keep them from shrinking. Dry the socks flat on a towel to prevent stretching. Replace the sock if it gets torn.

© 2014 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

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.

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