Chapter 9 Amputation

Length of stay is often limited by management of patient comorbidities. However, if well controlled, length of stay is usually 4-5 days pending adequate stump healing and evaluation by physical therapy.

9.1 Common Issues

  1. Wound infection or flap ischemia – sometimes it is difficult to distinguish, and these can present with erythema and drainage. Both may require washout and revision and should be monitored closely.

9.2 Perioperative Pathway

9.2.1 POD 0

  • Level of care: 7 Hudson North
  • Diet: Comorbidity specific diet
  • Activity: Bedrest
    • BKA: with knee immobilizer.
  • Labs:
    • PACU: CBC, Chem 7 depending blood loss and comorbidities
    • AM: CBC, Chem 7
  • Nursing:
    • Wound care: Dressing to be changed by MD
  • Medications:
    • Pain - Standing non-opiate analgesics and PCA
    • Restart home medications
    • Heme - DVT prophylaxis
    • Infectious disease - Stop antibiotics after 24hrs if operative site is clean, even when amputations are performed for infection
      • Bacteremia related to wound for which amputation is performed - continue antibiotics for 2 weeks to treat for bacteremia

9.2.2 POD 1-3

  • Activity: OOB with assistance, PT/OT evaluation
  • Medications
  • Pain - Transition to oral medications with IV medications for breakthrough

9.2.3 POD 4

  • Wound care: Ensure adequate pain control and remove dressings. Dry dressings only as needed. Evaluate leg for any pressure wounds and determine the need for immobilization