Name of the Procedure:

Amputation, thigh, through femur, any level; re-amputation

Summary

An amputation through the thigh, involving the femur, is a surgical procedure where a limb is removed at any level above the knee. Re-amputation refers to the process of surgically adjusting or re-doing a previous amputation.

Purpose

This procedure is often necessary to address complications from a prior amputation, such as infection, stump issues, or to improve prosthetic use. The goal is to resolve these issues, promote healing, and enhance the patient's quality of life and mobility.

Indications

• Severe infection or gangrene at the site of a previous amputation
• Poor healing or non-healing of the original amputation site
• Painful neuromas or phantom limb pain
• Complications with prosthetic fitting and usage
• Traumatic injury affecting the previously amputated limb

Preparation

• Patients may be required to fast for 8-12 hours before the procedure.
• Adjustment or cessation of certain medications as instructed by the surgeon.
• Pre-operative assessments may include blood tests, imaging studies, and evaluation of cardiovascular and respiratory function.

Procedure Description

1. The patient is placed under general anesthesia.
2. The surgeon makes an incision around the stump of the previously amputated limb.
3. Damaged or infected tissue is removed, with careful reshaping of the bone and muscle to create a better stump for prosthetic fitting.
4. Blood vessels and nerves are carefully managed and sealed.
5. The wound is closed with sutures or staples, and a sterile dressing is applied.

Equipment:

• Surgical scalpel and instruments
• Electric cautery device for managing blood vessels
• Suture materials

Duration

The procedure typically lasts between 1 to 3 hours, depending on the complexity of the case.

Setting

This surgery is performed in a hospital's operating room.

Personnel

• Orthopedic surgeon or vascular surgeon
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Infection
• Excessive bleeding
• Blood clots
• Delayed wound healing
• Phantom limb pain
• Neuromas (nerve tumors)
• Adverse reactions to anesthesia

Benefits

• Resolution of pain or infection issues
• Improved stump health and functionality
• Enhanced ability to use a prosthetic limb
• Improved overall quality of life

Benefits can often be realized within weeks to months following proper healing and rehabilitation.

Recovery

• Post-operative care includes pain management, wound care, and physical therapy.
• Patients may stay in the hospital for several days.
• Recovery time varies, typically spanning from a few weeks to several months.
• Patients should avoid strenuous activities until cleared by the surgeon and may need regular follow-up appointments to monitor healing.

Alternatives

• Continued conservative management with antibiotics and wound care.
• Debridement (removal of unhealthy tissue) without full re-amputation.
• Use of advanced wound healing therapies.

Alternative approaches may offer fewer risks but may not always provide the needed resolution of symptoms.

Patient Experience

Patients can expect a hospital stay, pain management strategies including medications and potential nerve blocks, and close monitoring of the healing process. Discomfort, pain, and restricted mobility may be experienced initially but should improve with time and appropriate care. Comfort measures and supportive therapies will be provided to encourage a smoother recovery.