Amputation Above the Ankle: Achieving the Best Outcome for the Patient

Abstract

The prevalence of major lower limb amputation for men aged 50–84 years in England is reported to be 26.3/100,000 (Ahmad N et al., J R Soc Med 107:483-489, 2014). Although this statistic is the focus of an ongoing systematic review (Meffen A et al., BMJ Open 10:e037053, 2020), we can be confident that diabetes represents a major risk factor for limb loss and as this disease becomes more common it is likely that amputation prevalence will rise despite improvements in limb salvage surgery.

Major amputation above ankle level often represents the final operation in a series of attempts at limb salvage from infection, ischaemia or both. Equally it could be the first and only operation and certainly should not be viewed in a negative sense as failure of treatment but rather an opportunity for a person to regain function within the boundaries of coexisting limitations or for others a means by which they may achieve durable relief from pain. For some people with advanced co-morbidities such as severe dementia, disabling stroke or heart failure, amputation may be ill advised, and a palliative care pathway preferred.

In this chapter we will propose a series of conceptual and technical decision points which if considered individually or in sequence will help achieve better outcomes for people facing limb loss. Pre, peri and post operative care are very important and are discussed. Surgical techniques are considered.