Definition
| Reasons for Procedure
| Possible Complications
| What to Expect
| Call Your Doctor
Definition
A below-the-knee amputation (BKA) is the surgical removal of the leg below the knee.
Reasons for Procedure
Possible Complications
Your doctor will review a list of possible complications. These may include:
- Poor healing of the amputation site resulting in need for a higher level amputation
- Skin breakdown at the stump
- Infection
- Decreased range of motion in the hip or knee joint
- Phantom sensation—feeling that the amputated limb is still there
- Phantom pain—feeling pain in the amputated limb area
- Swelling at the stump
- Bleeding
- Reaction to the anesthesia
- Heart attack
- Blood clots
Factors that may increase your risk of complications include:
- Poor blood flow
- Diabetes
- Infection or open leg/foot ulcers
- Not being able to move for a long time
- Heart disease
- Smoking or lung disease
- Advanced age
- History of clotting or bleeding disorders
Be sure to discuss these risks with your doctor before surgery.
What to Expect
Prior to Procedure
If your surgery is planned, your doctor will review the surgery and what to expect afterwards. He will also talk to you about how you are going to move after surgery. You may need a prosthesis (artificial limb), walker, crutches, wheelchair, or a combination of these after your surgery.
At your appointment before your surgery, your doctor may:
- Examine your leg (check pulses, skin temperature, skin appearance, and sensitivity to touch)
- Ask you questions like:
- What kind of help do you have at home?
- Would you like to talk to a therapist about the loss of your limb?
Questions you should ask your doctor include:
- What kind of rehabilitation will I need after surgery?
- How long will my recovery be?
Other things that may happen before your surgery:
- You may see a physical therapist who will explain your rehabilitation after surgery.
- You will be asked not to eat or drink for 8-12 hours before your surgery. Ask your doctor if you should take regular medicines with a sip of water before your surgery.
- Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the surgery. Medicines stopped may include:
Anesthesia
Either general anesthesia or regional anesthesia will be used. General anesthesia will block any pain and keep you asleep during surgery. It is given through an IV (needle) in your hand or arm. Regional anesthesia will numb your leg and the area surrounding it. You may also receive IV sedation.
Description of Procedure
Once you are asleep and no longer feeling any pain, a breathing tube will be placed if you have general anesthesia. The surgeon will make a cut in the skin below the knee. Next, the muscles will be separated and blood vessels clamped. A special saw will be used to cut through the bone. The muscles will then be sewn and shaped so that a stump is formed to cushion the bone. Nerves will be separated and placed so that they do not cause pain. Blood vessels will be tied off. The skin will then be closed over the muscles, forming the stump. Drains may be inserted into the stump to drain blood for the first few days after surgery. A dressing and compression stocking will be placed over the stump.
Immediately After Procedure
After the operation, you will be taken to the recovery room for observation. If all is well, your breathing tube will be removed while you are there. You will then be transferred to your hospital room to begin your recovery.
How Long Will It Take?
Several hours (depending on your health and the reason for the surgery)
How Much Will It Hurt?
During surgery, you will not feel pain. After surgery, you will be given pain medicine. You may feel phantom pain. If you do, tell your doctor.
Average Hospital Stay
5-14 days (Your doctor may choose to keep you longer if complications occur.)
Post-procedure Care
At the Hospital
- You will receive antibiotics to prevent infection.
- You may be taught how to change your dressing.
- Physical therapy will begin while you are in the hospital. Your therapist will show you how to stretch your hip and leg muscles to maintain range of motion. You will be taught how to get in and out of bed and eventually how to put weight on your leg. You may be taught how to use crutches, a walker, or a wheelchair until you can be fitted with a prosthesis.
While in the hospital, you may be asked to move your stump often. This will allow circulation and prevent contractures (stiffening of the knee joint causing loss of joint movement).
At Home
When you return home, do the following to help ensure a smooth recovery:
- Get help from family and/or friends as you recover.
- Change your bandages, replacing them with sterile bandages provided by the hospital.
- You will need to continue physical therapy to build your strength, maintain range of motion, and learn how to walk with a prosthesis.
- Take care of your stump and prosthesis.
- Many people feel depressed after this type of surgery. Consider talking to a therapist or psychologist about your feelings.
- Check with your doctor about which medicines to take at home.
- Be sure to follow your doctor's instructions.
Call Your Doctor
After you leave the hospital, call your doctor if any of the following occurs:
- Stump swelling
- Poorly fitting prosthesis
- Pain that is not controlled with pain medicines given
- Signs of infection, like fever or chills
- Redness, swelling, increasing pain, a lot of bleeding, or any discharge from the incision site
- Nausea and/or vomiting that you can't control with the medicines you were given after surgery, or which continue for more than two days after leaving the hospital
- Depression
- Cough, shortness of breath, or chest pain
- Joint pain, fatigue, stiffness, rash, or other new symptoms
In case of an emergency, CALL 911.
Last reviewed September 2009 by Ronald Nath, MD
All EBSCO Publishing proprietary, consumer health and medical information found on this site is accredited by URAC. URAC's Health Web Site Accreditation Program requires compliance with 53 rigorous standards of quality and accountability, verified by independent audits. To send comments or feedback to our Editorial Team regarding the content please email us at HLEditorialTeam@ebscohost.com.
This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.
Editorial Policy | Privacy Policy | Terms and Conditions | SupportCopyright © 2008 EBSCO Publishing All rights reserved.
