Amputation

Amputation stump problems

Limb amputation may be done for a variety of reasons, such as poor blood supply, diabetes, severe traumatic injuries or severe infection. As the designated Plastic Surgeon for the Swansea Artificial Limb Centre, I see the full range of problems that people with amputated limbs struggle with. These can interfere with their ability to use an artificial limb, such as:

• Painful, tethered scars

• Prominent bone ends with inadequate soft tissue

• Bulky stumps with excess soft tissue

• Spiky bony overgrowth

• Stump neuroma

• A cyst or pseudobursa

• Chronic wounds.

It is essential to have a multidisciplinary approach to these issues, because a prosthetist may be able to circumvent some of these problems by modifying the prosthetic socket. This ensures that patients can continue to walk on a prosthetic limb throughout.

Even if everything goes to plan and heals first time, it can take between 6 and 12 weeks to get back on a new leg. It is important to remember that the ultimate aim is to facilitate the fitting of, or weight-bearing on, a prosthesis. This may be achievable either with or without surgery.

Risks and complications

These are not uncommon, and include:

• Wound infection (up to 70%).

• Wound breakdown and delayed healing (up to 30%).

• Swelling and blistering.

• Phantom limb pain affects up to 80% of amputees and is described as pain experienced in the part of the limb that has been amputated. This is distinct from phantom limb sensation which is a non-painful sensation that the limb is still present. Pre-existing high levels of pain pre-amputation are associated with higher pain post-amputation, including CRPS. Phantom limb pain can be extremely difficult to treat and can be a severely debilitating condition that in rare cases can be unresponsive to treatment.

• Stump pain (also called residual limb pain) is described as pain within the amputation stump itself.

• Allodynia is a condition where pain is felt when a non-painful stimulus is applied (such as touch). Sometimes this can be alleviated with local anaesthetic medicated plasters or other desensitisation strategies.

• Bone pain may be experienced in the cut end of the bone. This can lead to difficulties with prosthetic fitting and pain management, occasionally necessitating revision surgery. Bone spur formation occasionally occurs with spicules of bone growing from the cut end of the bone that can impinge on soft tissues and may require revision surgery.

• Infection in the bone (osteomyelitis) or in the soft tissue can give rise to pain and requires management with antibiotics and sometimes surgery.

• Sinus formation can occur where there has been a collection in the amputation stump that drains through an opening in the skin. This can be a result of blood collection (haematoma) or infection and may require surgery.

• Muscle spasm or stump twitching can be very painful. It occurs where the muscles have been stretched and stitched into the bone to leave a stable, well-padded stump. This usually resolves once the muscles get used to their new position, but sometimes need treatment with Botox to relax the muscles.

• Neuroma formation can occur in an amputation stump wherever a nerve is cut. This is painful and can cause problems with prosthetic fitting and occasionally needs further surgery.

• Fixed joint deformity can occur where the joints do not have full movement and usually results from inactivity. This makes prosthetic use very difficult.

Psychological issues can occur due to an adjustment reaction to being an amputee, or a grief-type response to losing a limb.

This is why I work within a multidisciplinary team of experts at the Artificial Limb Centre in Swansea, so that patients get access to the full gamut of support required following an amputation or stump revision.