Name of the Procedure:

Amputation, leg, through tibia and fibula; re-amputation
Common names: Leg re-amputation, surgical leg removal

Summary

Amputation through the tibia and fibula involves surgically removing a portion of the lower leg. Re-amputation refers to performing this procedure again, often due to complications from a previous amputation or issues like infection.

Purpose

To address severe infection, poor blood flow, or failing previous amputation sites. The goal is to prevent further complications, alleviate pain, and improve the patient’s ability to use a prosthesis.

Indications

• Severe infection or gangrene in the residual limb
• Non-healing wounds or ulcers in the previous amputation site
• Persistent pain unresponsive to other treatments
• Poor blood circulation leading to tissue death
• Failed prosthetic function

Preparation

• Fasting for 8-12 hours before surgery
• Adjustments to medication, particularly blood thinners
• Preoperative imaging (X-ray, MRI) to assess the limb
• Blood tests to check for infection and overall health status
• Discussion of anesthesia options with the patient

Procedure Description

1. Anesthesia: General or regional anesthesia is administered.
2. Incision: A surgical incision is made through the skin and muscle to access the tibia and fibula.
3. Bone Cutting: Specialized surgical saws cut through the tibia and fibula.
4. Tissue Management: Removal of any infected or necrotic tissue.
5. Flap Creation: Healthy tissue is mobilized to create a flap for stump closure.
6. Closure: The wound is closed with sutures or staples, and a sterile dressing is applied.

Duration

The procedure typically takes 1-2 hours, depending on complexity.

Setting

Usually performed in a hospital operating room.

Personnel

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

Risks and Complications

• Infection at the surgical site
• Blood clots
• Negative reactions to anesthesia
• Phantom limb pain
• Delayed wound healing
• Need for further surgery

Benefits

• Relief from pain and infection
• Enhanced mobility with a properly fitting prosthesis
• Prevention of further health complications

Recovery

• Pain management with prescribed medications
• Wound care and dressing changes
• Physical therapy to strengthen remaining limb and improve mobility
• Follow-up appointments to monitor healing
• Avoid strenuous activities until cleared by a doctor
• Use of assistive devices (crutches, wheelchair) as needed

Alternatives

• Antibiotic therapy for infections
• Hyperbaric oxygen therapy for wound healing
• Revascularization procedures to improve blood flow
• Conservative management with dressing changes and offloading

Each alternative has variable success rates compared to surgery, with the primary trade-off being the risk of recurrent issues vs. surgical risks.

Patient Experience

Patients may feel discomfort and pain immediately post-surgery, managed through medications. Sensations of phantom limb pain may occur. Mobility may be limited initially, necessitating the use of crutches or a wheelchair, with gradual improvement as healing progresses and physical therapy is instituted.