Name of the Procedure:

Amputation, leg, through tibia and fibula; with immediate fitting technique including application of first cast

Summary

This surgical procedure involves the removal of the lower part of the leg through the tibia and fibula bones. An immediate fitting technique is used, which means a cast is applied right after the amputation to help shape the residual limb, promote healing, and prepare it for a prosthesis.

Purpose

This procedure addresses severe leg injuries, infections, or diseases that damage the tissues beyond repair. The goals are to remove the affected area, prevent the spread of infection, relieve pain, and eventually enable the patient to use a prosthetic limb for improved mobility and quality of life.

Indications

• Severe trauma or injury to the lower leg
• Severe infections that do not respond to antibiotics
• Gangrene or extensive tissue death
• Complications from diabetes (e.g., non-healing ulcers)
• Bone cancer or tumors
• Failed previous surgical attempts to save the limb

Preparation

• Fasting for 8-12 hours before the surgery
• Adjustments to certain medications as directed by the doctor
• Pre-surgical assessments including blood tests, imaging studies, and a complete medical evaluation
• Discussion with a physical therapist or prosthetist about post-surgical rehabilitation

Procedure Description

1. The procedure starts with the administration of suitable anesthesia, often general anesthesia.
2. The surgeon makes an incision through the skin and muscle to expose the tibia and fibula.
3. The bones are cleanly cut, and the surrounding tissues are carefully managed to create an optimal shape for prosthetic fitting.
4. Blood vessels and nerves are sealed off to prevent bleeding and manage pain.
5. The wound is closed, and a cast is immediately applied to the residual limb to help shape it and control swelling.
6. The patient is closely monitored as they wake from anesthesia, ensuring the cast fits properly and there are no immediate complications.

Duration

The procedure typically takes 2 to 3 hours.

Setting

The procedure is performed in a hospital operating room.

Personnel

• Orthopedic surgeon
• Anesthesiologist
• Surgical nurses
• Operating room technicians
• Prosthetist involved post-surgery

Risks and Complications

• Infection at the surgical site
• Excessive bleeding
• Blood clots
• Phantom limb pain
• Wound healing complications
• Issues with the fit and function of the cast or future prosthesis

Benefits

• Relief from severe pain or infection
• Prevention of further tissue damage or spread of disease
• Improved opportunity for rehabilitation with a prosthetic limb
• Enhanced mobility and quality of life

Recovery

• Initial hospital stay for monitoring and pain management
• Instructions for wound care and cast maintenance
• Follow-up appointments for cast adjustments and wound checks
• Gradual transition to a permanent prosthesis
• Physical therapy to adapt to the use of a prosthetic limb
• Full recovery can take several months, depending on individual health and rehabilitation progress

Alternatives

• Limb salvage surgery, if viable
• Long-term antibiotic treatment for infections
• Hyperbaric oxygen therapy
• The pros and cons of alternatives heavily depend on the specific medical condition and overall patient health; amputation may ultimately offer the best outcomes for certain severe cases.

Patient Experience

• Patients will be under general anesthesia and not feel any pain during the procedure.
• Post-surgery, they may experience pain and discomfort managed with medications.
• Psychological adjustment to amputation and use of a prosthetic limb may be necessary.
• Physical therapy will play a crucial role in recovery, aiming for gradual return to mobility and independence.