Both the cause of the amputation and each individual’s abilities will impact upon the time taken for rehabilitation and the eventual outcome. The time may vary enormously between individuals. You are encouraged to talk to your rehabilitation team about your particular situation and ask them how long it might take to move through the various stages. It is quite normal that you will go through some important stages without a prosthesis before you can consider getting a prosthesis and begin to learn to walk again.

Causes of lower limb amputation: Why do people need an amputation?

There are a variety of reasons why people require an amputation. The decision to amputate is a difficult one for all the people involved. For you, your family, and the medical staff looking after you.

Lower limb amputations make up about 90% of all amputations. They are most commonly caused by peripheral vascular disease (i.e. diseased blood vessels) and/or diabetes. These diseases decrease the blood supply to the leg and quite often people experience wounds or ulcers that don’t heal, infection, and associated pain. All of these factors affect the function of the leg and make it difficult for people to walk and move around freely. The incidence of amputation related to peripheral vascular disease and diabetes is more common in older people. It is also known that smoking cigarettes over a prolonged period of time damages the small vessels in the leg thus increasing the risk of amputation.

The remaining amputations of the lower limb are generally caused by accidents, for example at work or through motor vehicle accidents, through cancer or because of life threatening infectious diseases such as meningococcal septicaemia. Sometimes the surgeons may attempt to salvage the leg or as much as possible of the leg when removing a cancerous tumour or following trauma. It may take sometime before an amputation is finally decided upon.

In addition to the above so-called ‘acquired’ amputations, there is also a group of people born with ‘congenital’ amputations or ‘limb deficiency’. The needs of this group are quite different and management starts at a very early age.

About the amputation: How can I prepare for my amputation?

You are encouraged to take the opportunity to talk to your surgeon, other doctors, and the nurses and therapists involved before your amputation, and to ask them questions. This will help you gain a better understanding of what is involved with your operation, your immediate recovery, rehabilitation and some of the other issues associated with being an amputee.

Ideally a member of an amputee rehabilitation team may visit you in hospital before your surgery. You may also have the opportunity to attend an amputee clinic, to talk to the amputee rehabilitation team or someone else who has had an amputation.

Some of the things you may need to discuss with your Doctor and other staff prior to your amputation include:

1. Medical issues
It is helpful to have an idea about your medical history. Sometimes your local doctor might provide this information to the surgeon. This information is helpful in providing an understanding about the events leading up to your amputation, but also about other issues that might impact upon your recovery following the amputation.

2."What you were able to do before you started to get unwell, and how much you can do now"

Your current and previous level of function is important as it gives staff some idea about what to aim for following your amputation. You may be asked questions like "How far can you walk?" or "What were your activity levels before you became unwell?" Often people have been unable to use the affected leg for some time prior to amputation, that is being unable to walk, and have lost general fitness which needs to be regained as part of rehabilitation. Sometimes people have also needed help to be able to complete their day to day activities. It is helpful for the medical and therapy staff to have some idea about your past life, and about what you are having difficulty with now, so that they can plan for your rehabilitation following the amputation surgery. Other activities such as driving may also need to be discussed

3. "How you feel"

It is important that you talk about the events surrounding your amputation and how you are feeling about the decision. This will enable the staff working with you to help you adjust to having an amputation. It is acknowledged that your past and recent experiences may affect how you deal with the amputation and it is sometimes useful to talk about some of those experiences.

What happens on the day of my amputation?

Prior to your operation, the surgeon will explain at what level s/he expects to amputate and you (or your family) will be asked to sign a "Consent Form" giving them permission to operate.

Your amputation may be performed when you are completely unconscious (under a general anaesthetic). Alternatively, you may have a spinal anaesthetic that completely removes all movement and sensation from your leg. Generally, the decision about what sort of anaesthetic you will have is made by the surgeon and the anaesthetist looking after you.

When your operation is over you will return to the ward and will need to stay in bed that day. The nurses will be checking on you regularly throughout the day. Remember that an amputation is major surgery and it will take you some time to recover fully.