The numerous factors involved when deciding on whether to opt for an elective amputation

This informative article examines the numerous factors involved when deciding on whether to opt for an elective amputation.  A decision such as this is by no means an easy one and guidance will be given not only from the orthopaedic surgeon, but also a whole host of other medical specialists involved in making sure that the wellbeing of the individual is taken into account not only where it concerns the obvious implications to physical health, but, also in conjunction with other factors such as the emotional and psychological impact the procedure will have on total quality of life.

Roger Wolfson has treated many patients who have elected to have an amputation

Roger Wolfson has treated many patients who have elected to have an amputation.  In consultation with the orthopaedic surgeon who performs the amputation procedure, Roger helps to determine at what point the amputation level should be performed to allow the residual limb to best accommodate the new prosthesis.  It goes without saying that Roger’s involvement in the healing process is critical from the very beginning since he will be the one who is responsible for making sure that the new prosthesis delivers the very best possible outcomes.

From the point of view of the medical team, that is the surgeon, prosthetist and other specialists involved in treating patients who may require an amputation, the loss of a limb opens doors to new possibilities in restoring mobility.  Yet, for the person who is trying to come to grips with the decision of whether to let go of a part of their body, having an amputation is frequently too horrific to even contemplate.

An elective amputation involves a great deal more than a significant change to the body and lifestyle

The decision to have an elective amputation involves a great deal more than a significant change to the body, and the associated changes to lifestyle.  People who are in this position also face issues such as:

  • Grieving associated with limb loss
  • The implications of social stigma
  • Uncertainty around connecting with others who have had an amputation to gain a better idea of what it entails to live with an amputation

Factors that influence the decision to have an elective amputation

Numerous contributing factors influence the decision to have an elective amputation.  As with any major decision, weighing up the pros and cons and considering the unique circumstances of every individual is of utmost importance.  Let’s now examine some of the main factors involved.

Infection

Number one on this list is infection in that it presents the most serious of problems and is often the real deciding factor in determining whether amputation will be the best solution.  Infection presents a real medical issue since an infected limb causes one to feel unwell and the risk of the infection spreading further along with the possibility that sepsis may set in, causing strain and stress to the heart is likely.

The bone will not heal

It is often the case that while attempting to salvage the infected limb the bone does not heal.  This is often due to vascular damage that is responsible for the lack of blood flow to the limb and as a result if the bone still does not heal after a few months an intense effort to save the limb using additional skin and bone grafts ensues.  At this stage, the patient is in the position of having to sacrifice other parts of the body to save the infected limb which causes additional trauma.  The patient may then decide not to put stress on other parts of the body in order to save the limb and instead choose to have an amputation.

The prospect of living without pain

When an individual experiences severe pain the prospect of living life with an amputation and a prosthesis is often considered to be the best option.

Any injury or surgery causes pain.  Yet, with an infected limb there is often a situation of chronic and constant pain.  When one is constantly in pain it is difficult to maintain any sense of a normal life. 

Yet, the pain does not always disappear once the painful limb is removed.

It is at this stage that the patient will realistically consider an elective amputation since they start to think that once the problematic limb is removed, the pain will disappear.  But, this is not always the case.  Studies reveal that one cannot always anticipate what pain levels will be experienced following an amputation since approximately 15% of amputees experience severe pain and many people experience moderate levels of pain.  It is for this reason that deciding to amputate based on pain alone may not be the best option. 

Advances in technology might save the limb in the future

Often, a young person who is deciding whether to have an amputation may consider it best to do everything possible to salvage the infected limb in case advances in technology may provide better means of fixing the limb in the future. 

Lack of mobility

Where lower limbs are concerned, if the individual is still unable to put weight onto the infected limb after many months of attempting a salvage operation, the question often raised is:  What is the point of having this limb if I am still unable to walk properly?  The next question to ask is:  If I have an amputation, will I be able to successfully go through the rehabilitation process and be able to walk again?

Where upper limbs are concerned, being able to predict the level of functionality after amputation can also be extremely difficult.  Many patients find that they are disappointed in the limited functionality of prosthetic arms.  Yet, not having the amputation can mean continuous pain and living with a useless limb that just gets in the way. 

Case studies involving two of Roger’s patients who are elective amputees

Case Study i) Daniel Masaiti

Daniel Masaiti is a tobacco and livestock farmer from Marondera, a town situated just south of Harare, Zimbabwe.  

Now in his mid-fifties, Daniel was only four years old when he fell from a bicycle and sustained injuries that became infected and caused him to develop a condition known as osteomyelitis. 

elective amputation
Daniel Masaiti

Osteomyelitis is an infection of the bone, which is often triggered by staphylococcus aureus, a form of bacteria.  Antibiotics are administered upon diagnosis.  Yet, in Daniel’s case, even though he underwent various treatments over a protracted period of time, antibiotics eventually proved to be unsuccessful in alleviating the condition.  To prevent possible spreading or worsening of the situation, in 2016, Daniel elected to have a below knee amputation. 

Says Roger Wolfson: “Amputation is a critical salvage procedure when it comes to septic and tumour patients.”

Click here to read the full article:  Daniel Masaiti – a journey in walking comfortably short of three weeks post-surgery with Immediate Post-Operative Prosthesis (IPOP)!

Case Study ii) – Allan Merton

It was just over a year ago that 37 year-old Allan Merton, a Mold Shop Foreman from Brits who works for Bridgestone South Africa, elected to have a below knee amputation to his left leg due to repeated infections and pain following a severe leg break.

elective amputation
Allan Merton

“I had a funeral for my lost leg”

Allan explains: “After I fell and broke my leg, I kept on getting infections.  No matter what I did the infections wouldn’t heal. I wasn’t prepared to sit around for months or even years on end living with the consequences of repeated infections. After about 5 months of working with Dr Richard Kyte, the orthopaedic surgeon who did my procedure; and having tried every possible avenue in an attempt to save my leg; looking at the long-term prognosis of my condition going forward, once I had weighed up my options, I elected to have an amputation. This was the only way I could guarantee that there would be no more infections and no more pain. 

Taking a major decision such as this is not an easy task.  So, the way that I dealt with it was to literally have a funeral for my lost leg which definitely helped me to come to terms with the situation from an emotional and psychological point of view.  Once I had been through this “funeral ritual” I felt a lot better in knowing that I had made the right decision that would finally put an end to the pain and infections.” 

Allan’s condition is such that due to circulatatory disease resulting from injury, infection had set in which is caused by a deterioration of blood flow to the infected limb.

Read full article here:  https://rwaa.co.za/amputation/

A decision not to be taken lightly

Taking all factors into account, the decision to opt for an elective amputation should never be taken lightly.  Support is always available every step of the way.  Call Roger now for a free first consultation.