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Below The Knee Amputation In Children

WHAT YOU NEED TO KNOW:

What do I need to know about a below the knee amputation?

Below the knee amputation is surgery to remove your child's leg below the knee cap. Your child may need an amputation because of an injury, a tumor, or an infection. Problems with your child's leg veins or arteries, or a leg problem he or she was born are other reasons. The part of your child's leg that is not removed is called a residual limb. You and your child will be shown how to care for the residual limb. Your child can also work with specialists to have prosthetics made for him or her. A prosthetic will help your child return to his or her normal daily activities.

How do I help my child prepare for a below the knee amputation?

  • Talk to your child about what will happen during and after surgery. Depending on your child's age, he or she may have questions or concerns. He or she may worry about being able to walk or play sports. Talk to your child about options for a prosthesis. Assure him or her that the prosthesis will help with movement and sports. He or she may also worry about how other children will react to a prosthesis. Listen to your child's concerns and provide comfort and support. It may help to show your child pictures of children who have a prothesis. He or she may also be able to talk to another child who has a prothesis.
  • If your child is having scheduled surgery, his or her healthcare provider will talk to you about how to prepare. He or she may tell you not to let your child eat or drink anything after midnight on the day of surgery. He or she will tell you what medicines your child should take or not take on the day of surgery. Your child may be given an antibiotic through an IV to help prevent a bacterial infection. Tell your child's healthcare provider if he or she has ever had an allergic reaction to an antibiotic.
  • An angiogram may be needed to check the blood flow in your child's leg. A catheter (thin tube) is threaded into an artery in your child's groin. Contrast liquid is put into the catheter. X-rays are then taken to watch how the liquid and blood flow through your child's leg. Tell your child's healthcare provider if he or she has ever had an allergic reaction to contrast liquid. Another test may be done to test the oxygen levels in your child's leg. These tests help healthcare providers decide where the leg needs to be amputated.

What happens during a below the knee amputation?

  • Your child will be given general anesthesia to keep him or her asleep and free from pain during surgery. Your child's healthcare provider will try to keep as much of the leg as possible. Your child may still be growing, so surgery will be planned according to your child's age. An incision will be made in your child's leg below his or her knee. The part of the leg below that will be removed, and the thigh bone will be made smooth. A flap made of muscle, tissue, and skin may be used to cover the end of the bone. Tissue for the flap may come from other parts of your child's leg or foot.
  • If your child's leg was infected before surgery, healthcare providers may not put stitches or staples in to close it right away. The incision may be left open for several days after surgery. If your child did not have an infection, the flap will be closed with stitches. The stitches may be taken out about a month after surgery. Your healthcare provider may place a drain near the wound. The drain can help remove blood or extra fluid from the incision. This will help your child's limb heal faster.
  • A soft or hard bandage will be put over your child's residual limb. A soft bandage will be used if the incision was left open. The bandage will be covered with an elastic wrap. A cast will be put over the bandage if the incision was closed with stitches. The cast protects your child's residual limb from injury. The cast also makes fitting for a prosthesis easier and quicker. A prosthesis may be put on right after surgery.

What happens after a below the knee amputation?

  • Drains are thin rubber tubes put into your child's skin to drain fluid from around the incision. The drains are taken out when the incision stops draining.
  • Have your child take deep breaths and cough 10 times each hour. This will decrease your child's risk for a lung infection. Have your child take a deep breath and hold it for as long as he or she can. Your child should then let the air out and cough strongly. Deep breaths help open your child's airway. He or she may be given an incentive spirometer to help him or her take deep breaths. Your child will put the plastic piece in his or her mouth and take a slow, deep breath. Then he or she will let the air out and cough. Have your child repeat these steps 10 times every hour.
  • Activity guidelines:
    • Healthcare providers will help your child change position often while he or she is resting in bed. This moves fluids in your child's lungs, helping decrease the risk for pneumonia. This also helps prevent skin pressure sores, and keeps your child's muscles and tendons from tightening.
    • Your child will keep the residual limb raised on 1 to 2 pillows for the first 24 hours after surgery. This helps decrease swelling.
    • After the first day, your child's residual limb will stay flat on the bed to prevent his or her hip from tightening.
    • Your child will lie on his or her stomach twice a day. This also helps prevent hip tightening.
    • Healthcare providers will show you how to help your child start exercising his or her leg and residual limb. Your child will need to lift his or her leg off the bed and move it in big circles. This helps strengthen the leg, and may prevent blood clots from forming. He or she will repeat this movement with the residual limb.
  • Your child's residual limb will be wrapped. Healthcare providers will teach you and your child how to wrap the residual limb with an elastic bandage. This helps to control swelling, and helps to form the residual limb into a firm cone shape. This shape will fit into a prosthesis. Healthcare providers may start wrapping the residual limb within 1 to 3 days after surgery. They may wait until the cast is removed. At first, healthcare providers will not pull the elastic bandage very tight. They will pull the bandage tighter as your child's wound heals and the stitches are removed. They will rewrap the residual limb about every 4 hours to keep the bandage smooth and tight. Ask a healthcare provider to rewrap the bandage if your child's pain gets worse. This may mean the bandage is too tight.

What are the risks of a below the knee amputation?

During or after surgery, your child may bleed more than expected. Blood may collect under your child's skin and form a lump called a hematoma. This may need to be drained to prevent infection. It may be difficult for your child's wound to heal, and he or she may get a wound infection. Your child may get a blood clot in his or her leg or arm. This can cause pain and swelling, and it can stop blood from flowing where it needs to go in your child's body. The blood clot can break loose and travel to your child's lungs or brain. A blood clot in the lungs can cause chest pain and trouble breathing. A blood clot in your child's brain can cause a stroke. These problems can be life-threatening.

Care Agreement

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

© 2017 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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