Name of the Procedure:

Amputation, Leg, Through Tibia and Fibula
Common Name(s): Below-Knee Amputation (BKA)

Summary

Amputation through the tibia and fibula, commonly referred to as below-knee amputation (BKA), involves surgically removing the lower part of the leg below the knee. This procedure is typically performed due to severe injury, infection, or chronic illness affecting the lower leg.

Purpose

Amputation is performed to address severe limb damage that cannot be repaired, or chronic conditions like peripheral artery disease or diabetes that result in non-healing ulcers or gangrene. The goal is to remove the diseased or damaged portion of the leg to save the patient's life, alleviate pain, and allow for a prosthetic limb fitting, aiming to improve overall mobility and quality of life.

Indications

• Severe trauma or injury to the lower leg
• Chronic infections unresponsive to treatment
• Peripheral artery disease leading to tissue death
• Complications from diabetes causing gangrene or severe ulcers
• Malignant tumors in the lower leg or bones

Preparation

• Patients may need to fast for a period before surgery.
• Medication adjustments may be required.
• Preoperative assessments include blood tests, imaging studies, and a thorough medical evaluation.
• Psychological support is also provided to prepare for the loss of a limb.

Procedure Description

1. Anesthesia: Administered general or regional anesthesia to ensure the patient feels no pain during the procedure.
2. Incision: A circumferential incision is made around the leg below the knee.
3. Bone Cutting: The tibia and fibula bones are carefully severed.
4. Muscle and Tissue Management: Muscles and tissues are shaped for optimal prosthetic fitting.
5. Blood Vessels and Nerves: Blood vessels are tied off, and nerves are managed to minimize postoperative pain.
6. Closure: Incisions are sutured closed and dressed.

Tools and Equipment: Surgical scalpels, bone saw, cautery devices, sutures.

Duration

The procedure typically lasts 1 to 2 hours.

Setting

Performed in a hospital operating room or a specialized surgical center.

Personnel

• Surgeon
• Surgical team: Including a surgical assistant and nurse
• Anesthesiologist
• Operating room nurse

Risks and Complications

• Common risks: Infection, blood clots, and delayed wound healing.
• Rare risks: Phantom limb pain, further amputation needs, adverse reactions to anesthesia.
• Management: Postoperative antibiotics, blood thinners, pain management protocols.

Benefits

• Expected benefits: Removal of diseased tissue, pain relief, improved mobility with a prosthetic limb, enhanced quality of life.
• Realization time: Benefits may be felt immediately post-recovery or within several weeks after adjustment to prosthetics.

Recovery

• Post-op care: Wound monitoring, pain management, physical therapy.
• Expected recovery time: Several weeks to months, depending on the patient’s overall health and healing capacity.
• Restrictions and follow-up: Limited mobility initially, fitting for a prosthetic limb, regular follow-up appointments for progress evaluation.

Alternatives

• Conservative management: Continued attempts with antibiotics or limb-salvage procedures.
• Prosthetic-augmented procedures: Advanced reconstructions with bone grafts or vascular interventions.
• Pros and cons: Less invasive alternatives may preserve the limb but might not resolve severe issues, whereas amputation offers a definitive solution but at the cost of limb loss.

Patient Experience

• Intra-procedure: Patient will be under anesthesia with no sensations experienced.
• Post-procedure: Initial discomfort and pain managed with medication, possible emotional impact from limb loss. Pain management includes medications and therapies for phantom limb pain. Rehabilitative support aids in physical and emotional recovery.